Biomedical subjects

G Barbalias

Publications and source records attributed to G Barbalias.

At least 37 records · Page 2Linked to original sources

PubMed2001

The incidence of pharmacologically induced priapism in the diagnostic and therapeutic management of 685 men with erectile dysfunction.

OBJECTIVE: To evaluate the incidence of pharmacologically induced priapism in the diagnostic and therapeutic management of erectile dysfunction. PATIENTS AND METHODS: Over a period of 7 years, 685 men were investigated for erectile failure. They underwent a simple test with vaso-active drugs, and the nonresponders were further investigated. Eventually, 83 men began autoinjections and 45 still continue. RESULTS: Eight (1.2%) cases of priapism presented during the simple test with vaso-active drugs in these patients, while none occurred during self-injection treatment. Three were prolonged erections induced by prostaglandin E1 (PGE1) and 5 by papaverine (Pap). Six were treated safely with intracavernosal injection of etilephrine without blood aspiration. CONCLUSION: Priapism is always a potential phenomenon where no individual, no particular drug and no specific dose are completely safe. It may be caused even with 5 microg of PGE1 or 7.5 mg of Pap. Auto-injection therapy however is a safe kind of treatment in well-experienced patients. Careful regulation of the doses and practice in the use of vaso-active drugs may reduce the priapism rate.

Adult↗

PubMed1997

Use of slings made of indigenous and allogenic material (Goretex) in type III urinary incontinence and comparison between them.

OBJECTIVE: To evaluate the use of Goretex pubovaginal sling and compare the results with a typical indigenous material graft made of rectal fascia. METHODS: We have prospectively evaluated 48 consecutive patients in a randomized fashion in whom a sling procedure was performed to treat their type III incontinence. Sixteen women had a vesicourethral suspension (VUS) by a Goretex sling and another group of 32 patients, comparable in age range and medium age with the previous group, had a similar VUS by a sling from the rectus abdominis fascia. Both groups were evaluated urodynamically 6 and 30 months later. RESULTS: In the first group, cure of incontinence was observed in 87.5% and in the remaining patients it was significantly improved. In 2 patients there was an erosion of the urethra and the Goretex sling had to be removed 3.5 years later. Three other women remained dry but complained of occasional irritative symptoms. In the remaining 11 there was no erosion and the excellent postoperative result was maintained. In the group with fascial slings there was no erosion observed and in general they had less irritative symptoms. Cure or improvement of incontinence was comparable with the first group when studied 6 months after surgery, but there was a significant difference in the 30 months postoperative evaluation. CONCLUSIONS: Use of a Goretex sling provides better long-term results even though it is associated with somewhat increased morbidity.

Adult↗

PubMed1997

Lichen sclerosus et atrophicus. Findings after complete circumcision.

We prospectively evaluated 75 patients, 30-77 years old, with severe phimosis. All patients were treated surgically by complete circumcision and all surgical specimens were sent for histological evaluation. All patients with histologically proven lichen sclerosus et atrophicus (LSA) (eight patients, 10.6%) were re-evaluated 6 months postoperatively, and all but one were examined 5 years after the operation. All patients with histologically proven balanoposthitis (BP) (47 patients, 62.6%) were also re-evaluated 6 months postoperatively, and 41 patients 5 years after surgery. This group (BP) was the control group of our study. Six months after the operation, the eight patients with histologically proven LSA all had an excellent convalescence, and the lesions observed during the operation resolved in four patients and regressed in two patients. In one patient the glans presented with a pale grey-white-coloured plaque. Biopsy was performed and a well-differentiated squamous cell carcinoma infiltrating the glans was revealed. The control group of patients with histologically proven BP were also re-evaluated 6 months and 5 years after surgery. An excellent convalescence was observed in all patients who completed the follow-up examination. Care must be taken not to underestimate the potential relationship between LSA and squamous cell carcinoma, because the latter is usually invasive, very aggressive and requires immediate treatment.

Adult↗

PubMed1997

Using the ICSOoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS-'BPH' Study. International Continence Society--Benign Prostatic Hyperplasia.

OBJECTIVE: To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICSQoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. PATIENTS AND METHODS: The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICSQoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICSmale questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. RESULTS: The ICSQoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICSQoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICSQoL questions should not be combined into a score. General ICSQoL items were closely related with most domains of the SF-36 and the EuroQol. CONCLUSION: ICSQoL items may be used individually or as a group in research studies or in clinical practice.

Aged↗

PubMed1996

BCG versus epirubicin in the prophylaxis of multiple superficial bladder tumours: results of a prospective randomized study using modified treatment schemes.

A prospective randomized trial on 94 eligible patients evaluated and compared the efficacy of adjuvant intravesical epirubicin and bacillus Calmette-Guérin (BCG) after complete resection of multifocal superficial bladder cancer. BCG treatment schedule consisted of an induction 6-week course of instillations (150 mg Pasteur BCG per instillation) and single maintenance doses to patients who remained free of recurrences at follow-up examinations for a total treatment period of 2 years. These initial responders received additionally a separate 4-week course of therapy 6 months after the start of treatment. Chemoprophylaxis included an early (on the second postoperative day) instillation followed by 4 weekly treatments with epirubicin (50 mg per instillation) and then by 10 monthly treatments for the initial responders during the first year of follow-up and at every follow-up examination for a total treatment period of 2 years. The overall treatment results did not differ significantly between the 2 arms (54% of patients of the epirubicin group remained free of recurrences compared to 65% of those treated with BCG) for an identical mean follow-up of 35.1 months. However, a significant benefit in favour of BCG when compared with epirubicin was shown in patients who had stage T1 and grade 3 tumours and in terms of relative risk of recurrences, disease-free interval and recurrence rate per 100 patient-months. Both drugs were proved to be safe with manageable toxicity.

Adjuvants, Immunologic↗

PubMed1996

Urodynamic indices change as a result of transrectal microwave thermotherapy (TMT) in benign prostatic hyperplasia (BPH).

Fifty-three patients with BPH have been evaluated and treated with TMT with a follow-up at 7 months. The prostate was heated transrectally to 42-43 degrees C and the treatment consisted of 5 to 6 sessions. The duration of each session was 60 minutes. The urodynamic parameters studied revealed an increase of the maximum flow rate and a decrease of the detrusor opening pressure as well as the detrusor pressure at maximum flow. A significant improvement in the amount of residual urine was seen in all patients. Based on the above, we propose TMT as a viable alternative to open surgical or transurethral removal of the prostate. Furthermore, TMT may serve as a preferred treatment option in patients with indwelling urethral catheters and highly increased surgical risk.

Aged↗

PubMed1996

A model system for the investigation of urinary stone formation.

OBJECTIVE: To develop an in vitro model system for the investigation of calcium oxalate urinary stones under conditions of spontaneous precipitation. MATERIALS AND METHODS: Using a calcium-ion selective electrode and automatic titrator, a test solution was kept supersaturated with calcium oxalate and the rate of crystallization measured. RESULTS: During the spontaneous precipitation at constant supersaturation at 37 degrees C, the induction times required for the precipitation of calcium oxalate monohydrate were inversely proportional to the supersaturation of the solution. No transient phases were identified and the interfacial energy determined from kinetic analysis was 28.4 mJ/m2. The rates of precipitation showed a first-order dependence on the degree of supersaturation and were in good agreement with those reported for the in vivo formation of calcium oxalate monohydrate stones. CONCLUSION: This experimental model system allows precise measurements of the kinetics of calcium oxalate monohydrate. From the dependence of the rates of precipitation on supersaturation, a mechanism controlled by surface diffusion is suggested.

Calcium Oxalate↗

PubMed1996

Burch colposuspension versus stamey endoscopic bladder neck suspension: a urodynamic appraisal.

A total of 51 consecutive female patients with genuine stress incontinence who underwent a Burch or Stamey operation were clinically and urodynamically evaluated preoperatively at least 8 months postoperatively. Our study group consisted of 27 women who underwent the Burch colposuspension and 24 who had the Stamey endoscopic bladder neck suspension. The urodynamic parameters which were studied pre- and postoperatively were the maximum flow rate (Qmax), the residual urine (Vres), the first sensation (FS), the bladder capacity (BC), the maximum vesical pressure (Pves max), the detrusor pressure at maximum flow (Pdet/Qmax), the functional urethral length (Lfun) and the maximum closure pressure (Pclos max). The successful results of the operations were 89% for Burch and 83% for the Stamey procedure. As for differing objective urodynamic findings, the Qmax, Pclos max, Vres and Lfun for both groups were the only parameters which showed statistically significant difference after surgery. The statistical comparison of the postoperative urodynamic parameters of the two operative techniques showed that Lfun, Pves max and Pclos max had difference in favor of Burch colposuspension. There were not statistical differences in the other studied parameters. In conclusion, according to the differentiation in the values of Pclos max, Lfun and Pves max, the Burch technique seems to result in a higher increase of patient's urethral resistance.

Adult↗

PubMed1995

Reduced variance of latencies in pudendal evoked potentials after normalization for body height.

The value of the Somatosensory Evoked Potentials (SEP) in the assessment and detection of neurological disorders could be considerably enhanced if the normative standards of (SEP) characteristic parameters were normalized taking into account all other systematic sources of variance. The present study examines the influence of body height on the peak and interpeak latencies of the pudendal somatosensory evoked potentials. We examined the peak latency (L1) of the evoked potential recorded at the L1 vertebra and the onset latency (ONc) of the cortical evoked potentials, after stimulation of the pudendal nerve, as a function of body height in 40 normal male subjects (age 20-40 years). Significant positive correlation was found between both (ONc) latency and ONc-L1 interpeak latency and body height (H). Assuming that the latter is proportional to the length of the neural pathways, the experimental data were fitted using a theoretical model representing the conduction in the sensory neuraxis as a function of body height. Using the estimated fitting functions, we normalized our data with regard to a typical value of body height. The normalized values of the aforementioned latencies reveal a significantly reduced variance, as compared to the original ones, and consequently their diagnostic importance is significantly increased. Similar procedures applied to the L1 (spinal) latencies and the latencies of the bulbocavernosus reflex (BCR) reveal no correlation with body height and this is discussed on the basis of neuroanatomical considerations.

Adult↗

PubMed1995

Prognostic factors for the operative correction of stress urinary incontinence.

Investigating the reliability of using some clinical and laboratory parameters as long-term prognostic factors in properly selected patients for stress urinary surgery could help in the prediction of the long-term result in each case. Toward this goal 51 women were examined prospectively, after they were assessed by clinical and laboratory exams with particular emphasis on urodynamic studies. Out of this group, 41 patients had genuine stress incontinence, and 10 had mixed stress incontinence. Twenty-seven women underwent Burch colposuspension while 24 had Stamey endoscopic bladder neck suspension. In all patients clinical and urodynamic evaluation was done with the same methodology before the operation, and after one month and six months, respectively. The study indicated that 73% of the incontinent women were cured. According to the "analysis of variance" and "correlation analysis" methods the factors which were found to influence the operative result were as follows: (1) Clinical factors including preoperative urgency, U.T.I. and previous gynaecological operations. These factors had negative prognostic value, while the grade of incontinence did not influence at all the outcome of surgery. (2) Urodynamic factors including preoperative residual urine, immediate operative first sensation of micturition, maximum urine flow rate, pre- and immediate postoperative bladder capacity and functional length. These factors influence the operative result negatively or positively according to the deviation from the normal values. Furthermore, the important immediate postoperative change of the urodynamic values was found to determine the result of the operation.

Female↗

PubMed1995

In vivo estimation of radiation dose in renal pelvis and parenchyma during renography.

A method is presented for the determination of the spatio-temporal distribution of the radionuclide in the kidney and estimation of the dose in the renal pelvis wall and parenchyma, during renograms, on the basis of real data. A protocol was formulated by means of which the processing of the frames acquired in the various stages of the renogram enables the determination of the mass of the renal pelvis and the parenchyma as well as the time distribution of radioactivity in these compartments. The proposed methodology was applied to 30 normal subjects and 35 patients with obstructive nephropathy, acute and chronic obstructive uropathy and hydronephrosis. Our results, when compared with the MIRD dose estimations for the entire kidney showed slight deviations in normals, whereas very significant deviations were observed in the cases with pathology. This is due to the fact that the mass of the 'source' and 'target' organs as well as the biodistribution of the radiopharmaceuticals are essential in dose determination and were completely different in our calculations from those used in the MIRD estimations. Comparing the absorbed dose in renal parenchyma and pelvis wall with that estimated in vivo for the kidney considered as a system of one compartment, we found large differences only in abnormal cases. Differences were also noted between the absorbed dose in the aforementioned renal compartments depending on the considered abnormal renal states.

Adult↗

PubMed1994

Evaluation of urodynamic parameters following Burch colposuspension.

Burch colposuspension is a very popular operation for the correction of genuine stress incontinence, due to its very good long-term results. The effect of the operation on the urodynamic parameters at the level of the bladder neck evaluated in this study, and correlated with clinical outcome. A total of 29 female patients with urinary stress incontinence who underwent a Burch colposuspension were clinically and urodynamically studied pre- and postoperatively. The urodynamic parameters chosen pre- and post-operatively were: maximum flow rate, residual urine, first sensation, bladder capacity, maximum detrusor pressure, detrusor pressure at maximum flow, functional urethral length and maximum closure pressure. Complete cure was obtained in 76% of the patients and improvement in 14%, the overall success rate being 90% for a mean follow-up of 18.4 months (range 8-27). Comparison of the pre- and postoperative urodynamic data revealed that the maximum urine flow rate, functional urethral length, maximum urethral closure pressure and residual urine were changed significantly after the operation. There were no statistical differences in the other parameters. All the urodynamic results that improved, however, only arrived at the lower limits of the values accepted as standard for normal individuals. This fact, however, did not prevent a good clinical result.

Female↗

PubMed1993

Myelolipoma of the adrenal gland.

We report 2 cases of large adrenal myelolipoma. Although their fatty nature was found by a CT scan and there was no endocrine activity, surgery was done because of their size and the caused discomfort.

Adrenal Gland Neoplasms↗

PubMed1992

Prostatectomy in the very aged.

The number of very aged men who demand prostatectomy for benign disease is increasing. We have assessed surgery results in 79 patients operated during the last four years. Sixty-two underwent endoscopic and 17 open procedure. Mortality rate was 3.7%. Two patients died in the first week and one patient three weeks after surgery. Morbidity rate was 61% but did not significantly affect the final operative outcome. Operative success rate six weeks postoperatively was 87%, satisfactory for this age group. After detailed preoperative evaluation and postoperative care by specialized age care team, prostatectomy is safe, effective and involves low-cost treatment.

Age Factors↗

PubMed1992

Intravesical instillations of 4-epi-doxorubicin (epirubicin) in the prophylactic treatment of superficial bladder cancer: results of a controlled prospective study.

A controlled prospective study in 65 patients was done to evaluate the efficacy of intravesical epirubicin administration as prophylactic treatment in regard to the pattern of tumor recurrences after complete endoscopic resection of superficial transitional cell carcinoma of the bladder. Intravesical instillations of the drug were given weekly for 6 consecutive weeks and to the responders an intermittent maintenance therapy was administered for the first 2 years after each followup examination. Of the patients treated prophylactically with epirubicin 37% had recurrence within a total of 1,136 patient-months compared to 55% of the controls who were followed for a total of 436 months, a difference that was not statistically significant (p greater than 0.05). However, examining the results in another manner, the control patients demonstrated a significantly shorter mean interval to recurrence and higher recurrent tumor rate per 100 patient-months. To clarify further the efficacy of epirubicin therapy, comparisons of the treatment outcome according to several tumor factors were done. These comparisons revealed a significant benefit for those who received epirubicin with respect to history of tumor recurrences and multiplicity at presentation. Drug-induced toxicity was acceptable. Our study suggests that epirubicin is safe and effective against the recurrence of superficial bladder cancer.

Administration, Intravesical↗

PubMed1992

Prostate-specific antigen test: operating characteristics and assessment criteria in the diagnosis of prostatic cancer.

The sensitivity and specificity of prostate-specific antigen (PSA) in prostatic carcinoma is of considerable interest. In this study, we have assessed PSA and also correlations between positive and negative predictive values of PSA and the prevalence of prostatic cancer. Firstly, cutoff point must be selected as a positivity criterion for prostatic cancer, according to the purpose of the test. Besides sensitivity, all the other operating characteristics are dependent upon the prevalence of the disease. Specificity and positive predictive value increase while negative predictive value decreases when prevalence increases. As the relationship between the age and the prevalence of prostatic carcinoma is well known, the age of the patient becomes a variable of prominent importance when assessing the test.

Aged↗

PubMed1991

Unusual echinococcal cyst.

We report a case of a single echinococcal cyst that originated from the liver, and occupied the upper right retroperitoneal space and kidney. The diagnostic problems and the surgical procedure are discussed.

Aged↗

PubMed1991

Idiopathic granulomatous orchitis.

Our paper reports 7 cases of idiopathic granulomatous orchitis. Testicular trauma and genitourinary tract infection were the only important conditions in the past history, and were possibly related to the etiology of this disease. The clinical appearance of idiopathic granulomatous orchitis varies, and it is difficult to differentiate from testicular cancer, the diagnosis usually being made on histological examination after orchiectomy. For young patients and those with single testis, inguinal exploration and frozen section are recommended.

Adult↗