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Biomedical subjects

G Raviv

Publications and source records attributed to G Raviv.

At least 37 records · Page 2Linked to original sources
PubMed1996

Correlation of nocturnal penile tumescence monitoring duplex ultrasonography and infusion cavernosometry for the diagnosis of erectile dysfunction.

PURPOSE: Nocturnal penile tumescence monitoring was compared to penile duplex ultrasonography and pharmaco-infusion cavernosometry in 50 cases of erectile dysfunction. MATERIALS AND METHODS: Nocturnal penile tumescence was evaluated in all patients as normal or abnormal according to standard general criteria. The results were compared to penile duplex ultrasonography parameters (peak systolic velocity, normal greater than 35 cm. per second, and diastolic velocity, normal less than 5 cm. per second), and to the flow rate needed to maintain erection (normal less than 15 ml. per minute) with pharmaco-infusion cavernosometry. RESULTS: Of the 50 patients 26 had normal nocturnal penile tumescence, including 25 (96%) with normal penile velocity, 18 (69%) with normal penile diastolic velocity and 22 (85%) with normal flow to maintain erection. On the other hand, 24 men had abnormal nocturnal penile tumescence of whom 7 (29%) had abnormal penile blood flow velocity, 17 (71%) had abnormal diastolic flow velocity and 18 (75%) had high flow rate to maintain erection. CONCLUSIONS: Normal nocturnal penile tumescence appears to correlate well with normal systolic blood velocity and cavernosometry but poorly with diastolic blood velocity. On the other hand, a low correlation exists between abnormal nocturnal penile tumescence and abnormal diastolic blood flow or abnormal cavernosometry. Furthermore, no correlation exists between abnormal nocturnal penile tumescence and abnormal systolic blood flow. According to this observation we presume that nocturnal penile tumescence, penile duplex and infusion cavernosometry should be performed to achieve a reasonably accurate diagnosis.

Alprostadil↗
PubMed1996

The additional predictive value contributed by quantitative chromatin pattern description as compared to DNA ploidy level measurement in 257 superficial bladder transitional cell carcinomas.

The results of quantitative chromatin pattern description were compared with the determination of the DNA ploidy level, and the histological grading and clinical staging of superficial transitional cell carcinomas (sTCCs) of the bladder. We investigated whether this quantitative description adds useful information to the one obtained by the other methods used for predicting the biological behavior of sTCCs. The quantitative chromatin pattern description was carried out by means of the digital cell image analysis of Feulgen-stained nuclei in a series of 257 sTCCs. The results show that according to the clinical sequence "remission (134 patients) --> stable recurrence (101 patients) --> progression (13 patients) --> death (9 patients)', quantitative chromatin pattern description shows that certain areas of the nucleus undergo a continual process of condensation and that the distribution and spread of the chromatin becomes more and more heterogeneous. This is accompanied by a more frequent appearance of pale areas in the nucleus and an increase in nuclear size. Of the 257 sTCC patients, 148 had pTa/PpT1 grade I or III tumors. Of these 148, histological grading and clinical staging made it possible to correctly predict the biological behavior of the tumors of 120/148 (81%). DNA ploidy level determination increased this correct prediction from 81 to 84%. When the information contributed by quantitative chromatin pattern description was added to that contributed by the combination of histological grading, clinical staging and DNA ploidy level determination, the prediction level was 93%.

Adult↗
PubMed1996

[A new method of cancer treatment: the use of radiofrequencies in urological tumors].

This study reports our preliminary experience with interstitial radiofrequencies in the treatment of urological malignancies. Bipolar radiofrequency was interstitially delivered in four freshly removed human kidneys in an ex-vivo model. The kidney was perfused ex-vivo with 37 degrees C saline in order to mimic physiological conditions. Large reproducible and controlled lesions (hypereosinophilia and pyknosis) were observed in the parenchyma between the active needles. Further animal and human clinical studies are planned to precise the place of bipolar RF in the treatment or urological malignancies, and especially in kidney tumors.

Electrocoagulation↗
PubMed1996

[High-grade intraepithelial prostatic neoplasms: diagnosis and association with prostate cancer].

Prostatic intraepithelial neoplasia (PIN) fulfils the majority of requirements for a premalignant change in the human prostate. Forty-eight patients were diagnosed to have high grade PIN on prostatic needle biopsy. During a follow-up period, 23 (47.9%) were found to have adenocarcinoma on subsequent biopsies. We compared the patients age, the digital examination, the transrectal ultrasound appearance (TRUS) and the serum PSA level between those in whom cancer was detected subsequently and those with PIN alone. There was a statistically significant difference in the transrectal ultrasound appearance (TRUS) and the serum PSA level between the two groups (p < 0.001, p < 0.016 respectively). In conclusion, patients with high grade PIN, elevated serum PSA with hypoechoic zone on TRUS should be rebiopsied 3 months after the initial diagnosis. If the results are negative, close follow-up is mandatory.

Adenocarcinoma↗
PubMed1996

[Erectile dysfunction: the role of Rigiscan in the diagnosis].

OBJECTIVE: Nocturnal penile tumescence (NPT) was performed in all patients and was evaluated as normal or abnormal according to standardized general criteria. The results of NPT were then compared to penile duplex ultrasonography parameters peak systolic velocity (normal > 35 cm/sec) and diastolic velocity (normal < 5 cm/sec), and to the flow rate needed to maintain erection (normal < 15 ml/min) with pharmaco-infusion cavernosometry. RESULTS: Of the 50 patients, 26 showed normal NPT where 25 patients (96%) had normal penile systolic velocity, 18 patients (69%) had normal penile diastolic velocity, and 22 patients (85%) showed normal flow to maintain erection. On the other hand, 24 showed abnormal NPT, where 7 patients (29%) had abnormal penile blood flow velocity and 18 patients (75%) showed high flow rate to maintain erection. CONCLUSION: From this study, we can conclude that normal NPT appears to have a good correlation with normal systolic blood velocity and normal cavernosometry. However, this correlation is low when compared with diastolic blood velocity. On the other hand, a low correlation exists between abnormal NPT and abnormal systolic and diastolic blood flow or abnormal cavernosometry. According to this observation, we can presumed that NPT, penile duplex and infusion cavernosometry considering together should be performed in order to achieve a reasonably accurate diagnosis.

Humans↗
PubMed1996

[Intra-cavernous collagen analysis in impotence].

The role of the different components of the corpus cavernosum is very important in the physiopathology of erectile dysfunction. The precise function of collagen fibers in erectile physiology is controversial. We measured the different types of collagen (I, III, IV) in the corpus cavernosum of 26 impotent and potent men using cell image analysis and immunohistochemistry. We found differences in the distribution of collagen I, III, IV in each pathological group (arterial, caverno-venous, psychogenic). The augmentation of collagen I and the light diminution in collagen III makes the corpus cavernosum less compliant which translates clinically as an alteration in the filling of the vascular spaces and by dysfunction of the veno-occlusive mechanism. The diminution in collagen IV shows an alteration in the function of endothelial cells. The fact that in the psychogenic group we found also a diminution in collagen IV content, makes us infer that psychogenic impotence could be the first stage of an organic impotence.

Adult↗
PubMed1996

The computer-assisted microscope analysis of Feulgen-stained nuclei linked to a supervised learning algorithm as an aid to prognosis assessment in invasive transitional bladder cell carcinomas.

The aim of the present work is to ascertain whether additional information to grading and staging can be obtained for the prognosis of invasive bladder tumours (T2, T3, T4) by means of two computer-assisted methodologies. The first methodology relates to the digital image analysis of Feulgen-stained nuclei and the second to a supervised learning algorithm named Decision Tree. The digital image analysis of Feulgen-stained nuclei generated 11 variables for nuclear DNA content and 15 for quantitatively describing chromatin pattern. These 26 variables were submitted to a Decision Tree technique which produces multi-attribute logical classification rules by selecting informative variables and determining discriminatory values for each of them. A series of 41 patients for which the majority of the T2 bladder tumours (68%) were associated with a 'good' prognosis (remission) while the majority of the T3-T4 ones (77%) were associated with a 'bad' one (clinical progression or death) were submitted to the proposed approach. The results show that the decision tree was able to characterise the tumours associated with a 'bad' prognosis in the T2 sub-group (32%) and the tumours associated with a 'good' prognosis in the T3-T4 one (23%), by using only few image-generated variables (added to the clinical stage).

Adult↗
PubMed1995

The role of nuclear morphometry for predicting disease outcome in patients with localized renal cell carcinoma.

BACKGROUND: More than one-third of patients with localized renal cell carcinoma (RCC) will have disease progression after nephrectomy. Present histopathologic variables cannot accurately predict the outcome of individual patients. METHODS: Nuclear morphometry was performed by an image analyzer on histologic sections from 39 specimens of pathologic T1 and T2 classification RCC. All patients underwent radical nephrectomy and were followed for a mean of 7.6 years. A univariate analysis and then a multivariate stepwise regression method were used to correlate results with patients' outcome. RESULTS: The best predictors of disease free interval were mean nuclear elongation factor (MNEF) (P = 0.023), mean nuclear regularity factor (MNRF) (P = 0.034), and mean nuclear area (MNA) (N = 0.038). Univariate analysis identified a significant correlation between patient survival and MNEF (P = 0.009), MNRF (P = 0.020) and MNA (P = 0.023). Combination of MNEF and MNA was even more strongly associated with survival (P = 0.0013). Multivariate analysis revealed that MNA (P = 0.044) and MNEF (P = 0.045) correlated independently with survival. CONCLUSION: These results suggest that nuclear morphometry provides objective independent prognostic information for patients with localized RCC.

Adult↗
PubMed1995

Testicular seminoma: clinical significance of nuclear deoxyribonucleic acid ploidy pattern as studied by flow cytometry.

PURPOSE: We evaluated the clinical significance of deoxyribonucleic acid (DNA) ploidy pattern as a predictor of prognosis in patients with testicular seminoma. MATERIALS AND METHODS: Flow cytometric nuclear DNA analysis was performed on archival specimens from 65 patients with pure seminoma who underwent radical orchiectomy between 1970 and 1992. RESULTS: A total of 42 specimens (65%) exhibited a DNA diploid pattern, while 23 (35%) were DNA aneuploid. Diploidy was manifested in 73% of the stage I tumors versus 31% of stage II cancers (p = 0.004). No correlation was found between ploidy and histological type, size or local extension of the tumor. Tumor progression was observed in 5 patients, exclusively displaying aneuploid histograms (p = 0.0017), and 3 of them subsequently died of the disease. CONCLUSIONS: DNA ploidy pattern may provide important prognostic information for patients with testicular seminoma.

Adult↗
PubMed1995

Reconsidering the necessity of ipsilateral adrenalectomy during radical nephrectomy for renal cell carcinoma.

OBJECTIVES: Ipsilateral adrenalectomy is traditionally advocated as part of radical nephrectomy performed for renal cell carcinoma. The current study addresses the controversy of whether ipsilateral adrenalectomy should be performed routinely during radical nephrectomy. METHODS: A total of 225 patients were treated surgically for renal cell carcinoma over an 18-year period. Of these patients, 158 underwent nephrectomy and simultaneous ipsilateral adrenalectomy and the other 67 had sparing of the ipsilateral adrenal gland. A retrospective analysis of the medical records and assessment of the clinical and the pathologic data were performed. Rates of survival and progression were evaluated in a subgroup of 109 patients, further subdivided into 54 patients who underwent concomitant adrenalectomy and 55 patients with the ipsilateral adrenal preserved during surgery. RESULTS: Histopathologic abnormalities were detected in seven adrenal specimens (4.4%); however, only 3 patients (1.9%) had involvement of the adrenal by renal cell carcinoma. All cases of adrenal involvement were detected by the preoperative imaging modalities. Ipsilateral adrenalectomy did not improve the outcome in comparison to adrenal preservation. CONCLUSIONS: In view of the rarity of ipsilateral adrenal metastasis, the questionable prognostic merits of concomitant adrenalectomy, and the availability of accurate imaging modalities, we conclude that ipsilateral adrenalectomy is not necessary in the majority of the patients undergoing radical nephrectomy for renal cell carcinoma.

Adenoma↗
PubMed1995

Pitfalls in the detection of urinary extravasation following major urinary tract reconstructive surgery.

Urinary extravasation may complicate the postoperative course of urinary tract reconstructive surgery. Early diagnosis of extravasation is critical in the postoperative management. In this study we assessed prospectively the various diagnostic techniques employed in the detection and documentation of urinary extravasation in 76 consecutive patients who underwent major urinary tract reconstructive surgery. Assessment included measurements of the volume of the fluid obtained from the drains, analysis of serum to fluid creatinine ratio, detection of intravenously injected indigo dye and traditional radiographic evaluation. Urinary extravasation was detected in 7 patients (9.2%). Increased creatinine ratio had the highest diagnostic accuracy: 97.3%, sensitivity 71.4% and specificity 100%. Various radiological investigations had accuracy of 96%, sensitivity 85.7% and specificity 97.1%. The combined use of these methods detected all cases of urinary extravasation with sensitivity, specificity and total accuracy of 100%. Fluctuations in the volume of fluid in the drains and intravenous injection of indigo dye had lower accuracy, sensitivity and specificity and added very little to the workup. We conclude that radiological investigations and creatinine ratio analysis are highly accurate complementary methods for the early detection and monitoring of urinary extravasation following reconstructive urinary tract surgery.

Creatinine↗
PubMed1995

Evaluation of criteria for uvulopalatoplasty (UPP) patient selection using acoustic analysis of oronasal respiration (SNAP testing).

This study was designed to evaluate the acoustic parameters of sleeping oronasal respiration as determined by the SNAP system, to identify those that might aid in identifying appropriate candidates for uvulopalatoplasty (UPP). Eighteen UPP patients who completed preoperative and postoperative SNAP testing and assessment interviews were analyzed. Significant multiparametric changes subsequent to UPP were identified. These parameters were then correlated with subjective outcomes and predictive parameters were defined that may aid in the identification of patients who would be the most appropriate candidates for UPP. Predictive correlation with relief of snoring was noted when the relative loudness of velum-like snoring was greater than 12 dB and the snoring distribution was dominated by low-frequency (velum-like) snoring (> 85%). Objective and more accurate UPP candidate selection may be possible using SNAP testing.

Adult↗
PubMed1994

Malignant peripheral primitive neuroectodermal tumor (PNET) of the kidney.

We describe a 61-year-old patient with primitive neuroectodermal tumor (PNET) arising from the kidney. Despite intensive treatment including surgery, combination chemotherapy and radiotherapy, rapid progression of the tumor was encountered and the patient died within six months with widespread disease. This appears to be the first recorded case of PNET of the kidney.

Fatal Outcome↗
PubMed1994

Enhanced cytologic detection of early stage mouse bladder tumor following induction of uroepithelial cell shedding.

Previous studies from our laboratory have shown that some Escherichia coli endotoxins are capable of inducing massive normal urothelial cell shedding. In the present study we investigated whether endotoxin-induced shedding improves cytologic detection of early stage mouse bladder cancer. Mouse bladder tumor (MBT-2) cells were implanted intravesically in the submucosa of C3H female mice. Ten to 21 days later the bladders were irrigated with saline followed by instillation of endotoxin. The bladder contents of each mouse were aspirated and examined cytologically together with the bladder wash specimen. Shedding of epithelial cells was observed in only 32% of the saline irrigated specimens compared with 93% after endotoxin instillation (p < 0.00001). Analysis showed an overall accuracy rate of 39% after saline barbotage versus 78% following endotoxin administration (p < 0.00001). These results indicate that intravesical instillation of specific bacterial endotoxin significantly increases the extent of cytologic detection of early stage superficial bladder cancer.

Administration, Intravesical↗
PubMed1994

Ureteropelvic junction obstruction: relation of etiology and age at surgical repair to clinical outcome.

Ureteropelvic junction (UPJ) obstruction is a congenital anomaly either caused by intrinsic narrowing of the upper ureter or by extrinsic pressure on the ureter caused by aberrant vessels or fibrous bands. We reviewed 121 cases of pyeloplasties performed in our department for UPJ obstruction. The cases were grouped by age and by the underlying pathology. Postoperative urographic evaluation showed that dismembered pyeloplasty was successful in 98.4% of the patients, with no significant difference between age groups. Persistence or recurrence of preoperative symptoms occurred in some patients (16.6%). Extrinsic obstruction of the ureter was associated with better postoperative clinical results and less recurrence of symptoms.

Adolescent↗
PubMed1993

[Primary retroperitoneal extra-gonadal germ cell tumor].

Malignant retroperitoneal tumors are relatively rare. The most likely diagnosis by a surgeon encountering a retroperitoneal mass is metastatic disease, but primary retroperitoneal malignant disease or benign tumor should also be considered. The most common primary retroperitoneal tumors are lymphoma and sarcoma. Primary extragonadal germ cell tumors constitute 1-2% of all germ cell tumors, most of which are found in the mediastinum and retroperitoneum. We report the successful treatment of a 20-year-old man whose primary retroperitoneal extragonadal germ cell tumor was treated by chemotherapy and surgery.

Adult↗
PubMed1993

Localized renal cell carcinoma treated by radical nephrectomy. Influence of pathologic data and the importance of DNA ploidy pattern on disease outcome.

BACKGROUND: The course of patients with renal cell carcinoma may be considerably different. Approximately 50% with presumed localized disease have metastases after nephrectomy. Pathologic stage at diagnosis, histologic grade, and histologic type have been considered the most important predictors of prognosis. Nevertheless, subsets of patients within a specified stage and grade may have considerable differences in disease progression and survival. METHODS: Flow cytometric nuclear DNA analysis was used to study pathologic Stage I or II renal cell carcinoma in 54 patients who underwent radical nephrectomy between 1974 and 1983. RESULTS: Sixty-three percent of the tumors were diploid, and 37% aneuploid. A DNA diploid pattern was more common among Stage I tumors than Stage II tumors (69% versus 33%; P < 0.04). Progression occurred in 31% of the diploid tumors, whereas among the aneuploid group the progression rate reached 59% (P < 0.06). Considered as a single indicator, DNA ploidy pattern was strongly associated with patient survival. Ten years after surgery 79% of the patients who had diploid tumors and 50% of those with aneuploid tumors were alive (P < 0.02). CONCLUSIONS: Nuclear DNA ploidy may serve as an important prognostic variable for patients with early stage renal cell carcinoma.

Adolescent↗