Search PubMed⌕ Search

Biomedical subjects

H B Goldman

Publications and source records attributed to H B Goldman.

At least 19 recordsLinked to original sources
PubMed2002

Levels of urinary inter-alpha-trypsin inhibitor trimer as a function of age and sex-hormone status in males and females not forming stones.

OBJECTIVES: To determine if levels of inter-alpha-trypsin inhibitor (I alpha TI)-trimer differ in normal individuals based on age, gender or hormonal status, as the regulation of calcium oxalate (CaOx) crystallization inhibitors, e.g. by sex steroids, could be a mechanism contributing to the differences in CaOx urolithiasis between the sexes. SUBJECTS AND METHODS: Voided urine samples were collected from normal males and females. In Experiment 1 samples were grouped by gender and age, i.e. paediatric (PED) < or = 10 years, male (M) 21, female (F) 14; young adult (YGAD) 20-30 years, M 23, F 18; adults (AD), 35-50 year, M 25, F 13; adults aged > or = 60 years (> 60), M 24, F 16 (totals, M 93, F 61). In Experiment 2 samples were grouped by gender, age and hormonal status, i.e. PED, M 24, F 17; AD, M 24, F 22; > 60 and not on hormonal therapy, M 23, F 30; M > 60 and on androgen deprivation therapy (ANDEP) 18; and F > 60 on oestrogen supplementation, F+EST, 18 (total M 89, F 85). Levels of urinary I alpha TI-trimer were determined by immunoblotting and enhanced chemiluminescence, and relative densities of the bands determined. RESULTS: In both experiments the relative levels of I alpha TI-trimer were 2-7 times higher in M-PED than in all other groups of males (P < or = 0.007). Among adult males, I alpha TI-trimer levels were similar in all groups, including ANDEP (P > or = 0.9). There were no differences in the relative levels of I alpha TI-trimer among any of the groups of females, regardless of age or hormonal status (P > or = 0.7). CONCLUSIONS: In males a decrease in I alpha TI-trimer was associated with the onset of adulthood and entry into the 'stone-forming years'. Females did not show this decrease, and neither sex showed an increase in I alpha TI-trimer in the > 60 group, when the incidence of CaOx urolithiasis is supposedly declining. While changes in urinary I alpha TI-trimer levels in males may reflect maturational changes in the kidney, overall these data do not support the hypothesis that the age-related changes in the incidence of urolithiasis are paralleled by changes in the expression I alpha TI-trimer. Additionally, the sex steroids do not appear to acutely regulate the expression of I alpha TI-trimer in adults, making differences in I alpha TI-trimer levels unlikely to be the reason for the disparity in the incidence of CaOx urolithiasis between the sexes.

Adolescent↗
PubMed2001

Urological medical malpractice.

PURPOSE: Like all other medical and surgical practitioners, urologists are occasionally confronted with the unpleasant realization that they are being sued for medical malpractice. These suits are generated through any number of acts or failures to act during innumerable circumstances. We reviewed all urological claims presented to 1 representative insurance company and delineated the types of acts, settings, expenses and disposition of these claims. This review was performed to understand better the claims confronting urologists and provide future guidance to urologists in the medical malpractice setting. METHODS AND MATERIALS: Working with The St. Paul Companies 259 medical malpractice claims against urologists consecutively closed from 1995 to 1999 were reviewed. Claims were defined as urological malpractice when the insured-defendant in a malpractice claim was a urologist. Each claim was reviewed in terms of disposition, patient age, geographic location, office-hospital setting, purported negligent act, procedure if applicable, litigation status and expenses incurred. Data ascertained were then compared to national practice statistics provided by the American Urological Association (AUA) and American Medical Association. In addition, a literature search with the key words urology and malpractice was performed. Related pertinent documents were reviewed and incorporated into this analysis. RESULTS: We reviewed 259 urological medical malpractice claims closed between 1995 and 1999. During this period The St. Paul Companies insured various numbers of private practice urologists. In the years ending 1995 to 1999, 489, 492, 438, 377 and 426 individual urologists, respectively, were insured with respective premiums paid in the amounts of $6.27, $6.23, $5.80, $5.15 and $3.87 million. Claims were analyzed by AUA section. The greatest incidence of claims occurred in the Southeastern section, followed by the North Central, South Central, Mid-Atlantic, New England, Western and New York sections. According to AUA statistics the greatest number of practicing urologists are in the Southeastern section, followed by the Western, North Central, South Central, Mid-Atlantic, New York, New England and Northeastern sections. When analyzing average expenses, the New England section had the most costly claims, followed by the Mid-Atlantic, North Central, Southeastern, South Central, Western and New York sections with respective mean expenses of $266,887, $145,031, $47,667, $41,843, $38,365, $30,037 and $1,065 per claim, respectively. The greatest percent of claims arose from the categories of inpatient, adult and surgical procedures. Endourological procedures resulted in the greatest incidence of surgical claims. However, claims related to prostatectomy involved the most expensive claims with a mean cost of $185,345. Of the surgical procedures incidents defined as postoperative complications were the most common acts of negligence generating a malpractice claim. The majority of malpractice claims were filed in court but subsequently voluntarily dismissed by the plaintiff. CONCLUSIONS: Medical malpractice persists as an issue confronting urologists. Urologists must strive to maintain open, honest, in-depth communications with their patients when occurrences with potential malpractice overtones arise.

Humans↗
PubMed2001

In situ anterior vaginal wall sling.

PURPOSE: The aim of this article is to review the indications, technique, and outcomes of the in situ anterior vaginal wall sling (AVWS) for treatment of female stress urinary incontinence. MATERIALS AND METHODS: The operative techniques and the published literature on outcomes of the AVWS were reviewed. RESULTS: Success rates in the range from 70% to 95% were noted. Some authors found that patients with a lower Valsalva leak point pressure (VLPP) had lower success rates than those with a higher VLPP. CONCLUSIONS: The AVWS is a technically straightforward minimally invasive procedure for treatment of stress urinary incontinence that minimizes patient morbidity and avoids some of the potential problems associated with other sling materials.

Female↗
PubMed2001

The in situ anterior vaginal wall sling: predictors of success.

PURPOSE: We assessed the outcome of the in situ anterior vaginal wall sling for stress urinary incontinence, identified any predictors of success and reviewed the current literature on this topic. MATERIALS AND METHODS: We identified all patients who underwent an isolated anterior vaginal wall sling procedure in a 16-month period. Charts were reviewed and telephone interviews were performed to assess the success rate of the procedure and identify parameters that may influence outcome. The pertinent literature was identified. RESULTS: Of the 42 patients identified 39 had evaluable data available. The overall success rate was 79.5% at an average 19-month followup. Abdominal Valsalva leak point pressure 50 cm. water or greater was identified as a significant predictor of success (p = 0.002). The success rate was 93% and 40% in patients with a Valsalva leak point pressure of 50 or greater and less than 50 cm. water, respectively. The pertinent literature was reviewed. CONCLUSIONS: The anterior vaginal wall sling is effective for stress urinary incontinence. In patients with a Valsalva leak point pressure of 50 cm. water or greater the success rate is 93%. We recommend the anterior vaginal wall sling procedure in these patients but different treatment in those with Valsalva leak point pressure less than 50 cm. water.

Female↗
PubMed1999

Voiding dysfunction in women with diabetes mellitus.

Voiding dysfunction is a common finding in women with diabetes mellitus. A full spectrum of bladder dysfunction, from areflexia to detrusor instability, can result. Urodynamics is frequently required to identify the specific disorder. Current concepts regarding the evaluation and treatment of these patients are reviewed.

Cystoscopy↗
PubMed1999

Voiding dysfunction in women with lumbar disc prolapse.

A significant proportion of women with lumbar disc prolapse experience voiding dysfunction. The most common finding is detrusor areflexia, frequently associated with impaired sensation. The pertinent neuropathophysiologic findings, clinical features and methods of evaluation and treatment are reviewed.

Cystoscopy↗
PubMed1999

The efficacy of urethrolysis without re-suspension for iatrogenic urethral obstruction.

PURPOSE: Urethral obstruction following surgical correction of stress urinary incontinence is not uncommon and urethrolysis is typically used to relieve symptoms. Whether one should resuspend the bladder neck concurrent with urethrolysis is controversial. We evaluate the efficacy of urethrolysis without re-suspension for the treatment of iatrogenic urethral obstruction. MATERIALS AND METHODS: From April 1994 to January 1998, 31 women 29 to 78 years old (mean age 60) underwent transvaginal urethrolysis without concomitant re-suspension. The incident procedure was transvaginal urethropexy in 15 patients (48%), retropubic urethropexy in 5 (16%) and pubovaginal sling in 11 (36%). The most common presenting complaints were urinary retention, feeling of incomplete emptying or straining to void in 22 patients (71%) and irritative voiding symptoms in 17 (55%). Mean time from index procedure to urethrolysis was 14 months (range 2 to 36) and mean followup was 7 (range 1 to 27). RESULTS: After urethrolysis 26 of 31 patients (84%) voided well or had significant improvement in symptoms. Of the 26 improved patients 6 had stress incontinence. Of these 6 patients 4 responded to periurethral collagen injection and are now dry. When individual variables were analyzed, none was found to be predictive of a successful outcome. CONCLUSIONS: Transvaginal urethrolysis without concomitant re-suspension is an effective treatment for iatrogenic urethral obstruction. While 19% of patients may have recurrent incontinence, the majority can be treated with outpatient collagen injections. Overall 77% of patients voided well without incontinence, 7% voided well but with some incontinence and 16% remained obstructed after urethrolysis.

Adult↗
PubMed1998

Effect of prostate biopsy on the results of the PSA RT-PCR test.

OBJECTIVES: To evaluate the effect of prostate biopsy on the prostate-specific antigen (PSA) reverse transcriptase-polymerase chain reaction (RT-PCR) test. METHODS: Ninety men who were scheduled to undergo prostate biopsy because of an elevated PSA or abnormal digital rectal examination, or both, were recruited to have PSA RT-PCR performed on peripheral blood samples drawn before and at 30 minutes, 1 week, and 1 month after undergoing prostate biopsy. PSA RT-PCR was performed and all PCR products were blotted and hybridized with phosphorus-32 (32-P)-PSA cDNA probe (exon 3 to 5). RESULTS: Of 90 patients, 77 had a negative prebiopsy PSA RT-PCR result. Of these 77, 2 (2.6%) had a positive PSA RT-PCR result at some point after the biopsy procedure. Both of these patients had no evidence of malignancy on biopsy. The PSA RT-PCR test was positive at 30 minutes for 1 patient, but was negative at 1 week; the other was positive at 1 week but the patient did not return for the 1-month sample. CONCLUSIONS: Our study indicates that 2.6% of patients with an initially negative PSA RT-PCR will have a positive PSA RT-PCR test after biopsy has been performed. Although this is uncommon, it may have profound implications for those patients in whom it occurs. On the basis of our results, it appears that one should wait longer than 1 week after prostate biopsy before obtaining blood for PSA RT-PCR testing to decrease the likelihood of a spurious PSA RT-PCR result.

Aged↗
PubMed1998

Traumatic injuries of the female external genitalia and their association with urological injuries.

PURPOSE: To date trauma to the female external genitalia has been incompletely characterized. At our institution a large number of such patients have been identified and many had associated urological injuries. We characterize these injuries and their association with urological injuries. MATERIALS AND METHODS: We reviewed the charts of all female patients presenting with trauma to the genitalia unrelated to parturition between 1991 and 1996. Type and mechanism of injury, associated injuries and blood transfusion requirements were noted. Vaginal injuries were classified as complex (greater than 3 cm., multiple or involving deeper structures) or simple (all others). RESULTS: We identified 20 women a mean 20.7 years old with traumatic injuries to the genitalia, including motor vehicle accidents in 6, injury from consensual intercourse in 5, sexual assault in 4 and other penetrating injuries in 5. There were 15 patients with vaginal injuries (complex in 8 and simple in 7) and vulvar injuries in 5. Six of the 20 women (30%) had associated urological injuries (urethra in 1, bladder in 4, ureter in 1 and kidney in 3) [corrected], including 3 associated with blunt trauma (all complex vaginal injuries) and 3 associated with penetrating trauma (simple vaginal or vulvar injuries). CONCLUSIONS: Traumatic injury to the female genitalia unrelated to parturition is more common than previously reported. Of the women with such injuries 30% have coexisting urological injuries. Thus, it is important to assess completely all women who present with external genitalia trauma for possible coexisting urological injury.

Adolescent↗
PubMed1997

Can prostate-specific antigen reverse transcriptase-polymerase chain reaction be used as a prospective test to diagnose prostate cancer?

The present study addressed the question as to whether prostate-specific antigen reverse transcriptase-polymerase chain reaction (PSA RT-PCR) could be used to identify prospectively men who have prostate cancer and to help determine which patients with an initially negative biopsy would benefit from rebiopsy. PSA RT-PCR was performed prospectively on 90 patients who were to have a prostate biopsy because of an elevated PSA level, an abnormal digital rectal examination, or both. PSA RT-PCR was performed, and the sensitivity of the test was enhanced by hybridization of the PCR with a 32P-labeled PSA cDNA probe (exons 3-5). Of the 90 men, 36 (40%) had prostate cancer on biopsy. Of these 36 men, 5 (13.9%) had a positive PSA RT-PCR finding, whereas 31 (84.1%) tested negative. Of 54 men with negative biopsies, 8 (14.8%) had a positive PSA RT-PCR result. The sensitivity of PSA RT-PCR for the detection of biopsy-proven prostate cancer was 13.9% and the specificity was 85.2%. Only 3 of 12 (25%) patients with advanced disease had a positive test result. The sensitivity of PSA RT-PCR for the detection of biopsy-proven prostate adenocarcinoma in men suspected of having prostate cancer is poor. Indeed, men without biopsy-proven prostate cancer are just as likely to have a positive result in the PSA RT-PCR as are men with cancer. Whether these men with negative prostate biopsies and positive PSA RT-PCR findings may eventually develop prostate cancer remains to be determined. At this time, PSA RT-PCR for the prospective detection of prostate cancer should be considered investigational.

Adenocarcinoma↗
PubMed1997

Lower urinary tract dysfunction in patients with gastroparesis.

PURPOSE: We characterized the bladder dysfunction in patients with idiopathic gastroparesis and compared it to findings in those with gastroparesis secondary to diabetes mellitus. MATERIALS AND METHODS: The clinical and urodynamic records of 17 patients with gastroparesis (10 idiopathic and 7 secondary to diabetes mellitus) were retrospectively reviewed. RESULTS: Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. Overall this population demonstrated diminished bladder sensation, increased capacity, decreased flow rates, elevated post-void residuals and increased rates of abdominal straining. Patients with idiopathic gastroparesis had more severe dysfunction than those with gastroparesis secondary to diabetes mellitus. CONCLUSIONS: An association between idiopathic gastroparesis and bladder dysfunction exists. These patients have bladder dysfunction that parallels but is more severe than that in patients with gastroparesis secondary to diabetes mellitus. A common autonomic neuropathic syndrome may account for both problems.

Adult↗
PubMed1997

The use of urine cytology for diagnosing bladder cancer in spinal cord injured patients.

PURPOSE: The diagnosis of bladder cancer in spinal cord injured patients is complicated by inflammatory changes caused by long-term indwelling catheters, which make cystoscopic followup difficult. We evaluated cytology as an aid in diagnosing bladder cancer in spinal cord injured patients. MATERIALS AND METHODS: The charts of 208 spinal cord injured patients were reviewed retrospectively from January 1988 to July 1995 to define the value of cytology in the diagnosis of bladder cancer in this population. In all patients at least 1 urine cytology study was done less than 3 months before bladder biopsy. We examined 272 bladder biopsies (several patients underwent more than 1 biopsy at least 1 year apart) with 1 to 6 cytology studies done before biopsy. RESULTS: Cytology results were classified as negative-no malignant cells, inflammation or benign urothelial cells, reactive-atypia or atypical reactive and suspicious-atypical suspicious, keratinizing squamous metaplasia, suspicious for cancer, cancer or dysplastic. A total of 960 cytology specimens was obtained before the 272 biopsies (average 3 before each biopsy). Of 17 patients with cancer 12 had at least 1 prior suspicious urine cytology result. The sensitivity and specificity of cytology were 71 and 97%, respectively, when evaluating only patients with suspicious findings. CONCLUSIONS: The high sensitivity and specificity of multiple cytology studies in this population suggest that cytology is a useful adjunct to improve the detection of bladder cancer in spinal cord injured patients with chronic (longer than 5 years) indwelling catheters. We recommend a minimum of yearly cytology in all high risk spinal cord injured patients with subsequent biopsies in all patients with any suspicious finding.

Humans↗
PubMed1996

Penetrating trauma to the penis: functional results.

PURPOSE: The erectile function, cosmetic appearance, indications for surgical exploration and need for specific diagnostic tests were evaluated in patients with penetrating penile trauma. MATERIALS AND METHODS: We reviewed 26 cases of penetrating penile trauma seen during a 4-year period. RESULTS: All patients with corporeal injuries who were followed (73%) were potent. Two patients with minimal corporeal injury who did not undergo exploration did well. Retrograde urethrography did not identify any previously unsuspected urethral injuries. CONCLUSIONS: Excellent functional results may be obtained after penetrating trauma to the penis. Select patients may not require retrograde urethrography and some with minimal wounds, even if involving the corpora, can be treated nonoperatively.

Adolescent↗