Biomedical subjects
Publications and source records attributed to J D Schmidt.
We report a case of polyarteritis nodosa initially presenting as acute orchitis and review 4 similar reports in the literature. Of the cases 2 were diagnosed preoperatively. In 2 cases in which immunological markers were measured abnormal values were obtained. All 5 cases required biopsy for diagnosis.
PURPOSE: The purpose of this study was to use color-flow duplex scanning to identify the anatomic distribution of venous reflux and to quantify venous reflux times in patients with various stages of chronic venous insufficiency (CVI). METHODS: Color-flow-assisted duplex scanning was used to identify the anatomic distribution of venous reflux and to quantify reflux times in the deep and superficial venous systems of patients with symptomatic (CVI). Two hundred two patients with class I to III CVI were examined. RESULTS: Only 11% (22 patients) had a documented history of phlebothrombosis. Of the 403 limbs evaluated, 192 had venous ulcers whereas 211 were classified as having class I or II CVI. Nonocclusive venous obstruction was found in only 16 limbs (4%). Venous ulceration was significantly associated with reflux in multiple venous segments as opposed to reflux in isolated venous segments (p < 0.001). Total limb reflux time (Rt) was determined by summing the reflux times of all the venous segments in a limb. The mean Rt of patients with venous ulcerations was significantly longer than the mean Rt of limbs with class I and II CVI (p < 0.01). A total limb reflux time of greater than 9.66 seconds was predictive of ulceration. Total limb deep segment reflux time and total limb superficial segment reflux time were also determined by summing the reflux times of the appropriate segments in the limb. The mean deep segment reflux time was prolonged in limbs with venous ulcers when compared with limbs with class I and II CVI disease. The mean superficial segment reflux time of limbs with class I and II CVI and limbs with venous ulcers could not be used to distinguish between the two groups. In assessing the contribution of segments of the deep system to ulceration, reflux times of different segments were compared with wound duration and area. Reflux in the common femoral vein was significantly associated with wound area and duration (p < 0.05) whereas reflux time in the distal posterior tibial vein was associated with wound duration (p < 0.05).
BACKGROUND: The clinical diagnosis of localized prostate carcinoma in the asymptomatic male has been based on a careful digital rectal examination (DRE). METHODS: The DRE, prostate specific antigen (PSA), transrectal ultrasonography (TRUS), prostate needle biopsy (PNB), and other modalities are examined for their role in prostate cancer diagnosis. RESULTS: Up to 20% of localized prostatic cancer is still diagnosed "retrospectively" on transurethral resection (TURP) for clinically benign disease and prostatism. The role of fine-needle aspiration (FNA), flow cytometric study (FCM), and magnetic resonance imaging (MRI) in the diagnosis of prostate cancer is limited. CONCLUSIONS: Those men older than 50 years of age who have lower tract symptoms, either obstructive or irritative, or who have abnormal serum levels of PSA, regardless of DRE findings, are advised to undergo TRUS with ultrasound-guided PNB.
Explore the source record for details and available documents.
Adrenal myelolipomas are rare, benign neoplasms composed of mature fat and bone marrow elements. Most are small, asymptomatic tumors found incidentally at postmortem examination. We report the natural history of an adrenal myelolipoma in a middle-aged woman during a 4-year interval.
A 35-year-old man with the acquired immunodeficiency syndrome-related complex was evaluated for a persistent urethral discharge, pneumaturia and watery diarrhea. Radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula. Perineal exploration and excision of the fistula revealed the pathological diagnosis of Kaposi's sarcoma. The differential diagnosis of an acquired rectourethral fistula and the significance of Kaposi's sarcoma are discussed.
Explore the source record for details and available documents.
Twelve extracorporeal shock-wave lithotripsy (ESWL) treatments were performed on 10 patients with a solitary kidney. Nine patients had a ureteral stent placed pretreatment. Nine patients were available for follow-up. Seven (78%) were stone free or had insignificant fragments at three months. Complications were seen in 4 patients, including two instances of pyelonephritis. Failures were associated with an increased stone burden. ESWL is an effective and safe treatment for upper urinary tract stones in patients with a solitary kidney. We recommend pretreatment stenting in patients with a solitary kidney.
Urinary incontinence after prostatectomy can be psychologically and socially disabling. We reviewed our experience with 27 patients who were incontinent between 5 and 198 months after either radical retropubic, total perineal or transurethral prostatectomy. These patients were entered into our bladder behavior clinic, which was administered by nursing staff with physician supervision. Patients were strongly encouraged to discontinue the incontinence devices, and were then evaluated for the type and extent of incontinence. Perineal exercises were demonstrated in detail, tested for their correct use via simultaneous rectal and abdominal examination, and applied to the pattern of incontinence. Patients were evaluated frequently for compliance and their progress was followed with instruction repeated as needed. Pharmaceutical agents were not used. Among the 24 patients evaluable over-all improvement in the number of incontinent episodes was 56.6% (p less than 0.001). Two patients (8.3%) achieved total continence, 10 (42%) improved greatly, 4 showed moderate improvement and 8 (33%) showed essentially no change. Transurethral and perineal prostatectomy patients improved by 74 and 61%, respectively, versus only 33% in the radical retropubic group (p = 0.14). In addition, patients who previously underwent transurethral resection before total prostatectomy did worse (18%) than did those who did not (67%). We conclude that a significant number of patients who are incontinent after prostatectomy (especially those without a prior transurethral resection) can improve dramatically with a behavioral training program that provides a strong support system.
Hematuria may be of glomerular or nonglomerular origin. Dysmorphic erythrocytes are found in the urine of patients with glomerular bleeding, whereas isomorphic erythrocytes characterize nonglomerular or urological hematuria. Urine specimens from 100 patients with microscopic hematuria were collected: 50 had a known glomerular pathological condition and 50 had urological disease. Scanning electron microscopy of the urine specimens showed a marked difference in morphology between dysmorphic and isomorphic red blood cells. This differentiation can be made with a simpler instrument, the standard Coulter counter. Accurate prediction of glomerular versus nonglomerular hematuria was made in 97 of the 100 patients by Coulter counter analysis. The test is rapid, simple and readily reproducible. A permanent graphic record of the red blood cell morphology can be obtained for each patient. Identification of glomerular versus nonglomerular hematuria can be of practical use in the clinical management of patients.
The investigators of the National Prostatic Cancer Treatment Group (NPCTG) have entered 212 patients with surgically confirmed stage D-1 prostate cancer in studies to determine the efficacy of adjuvant therapy after either definitive surgery (Protocol 900) or definitive radiotherapy (Protocol 1000). Follow-up indicates that this group represents 70% of all patients with recurrent disease. Because patients with less than 20% nodal involvement were found to have a statistically significant better progression-free-survival (PFS) than those with greater than 20% nodal involvement, we examined the exact anatomic sites of nodal metastases. The status of obturator, external iliac, internal iliac, and common iliac nodes was compared to PFS and overall survival in 198 patients with D-1 disease in both protocols. Results demonstrate no significant difference in either PFS or overall survival relative to anatomic sites of positive nodes. These data suggest that although minimal pelvic nodal metastasis is consistent with improved PFS, there is no predictable anatomic distribution of disease consonant with that better prognosis.
A total of 29 patients underwent 32 operations for correction of penile curvature. Of these patients 22 underwent placement of a semirigid prosthesis and 94 per cent of those available for followup were able to resume coitus. Of the 8 patients who underwent operative correction of penile curvature and who maintained potency only 3 (38 per cent) were able to resume intercourse. Vascular compromise and/or skin slough after degloving of the penile skin was noted in 3 patients. A proximal approach to penile reconstruction is presented.
Explore the source record for details and available documents.
Prior studies in our laboratory have shown that the bladder surface is lined with glycosaminoglycans which appear to be an important antibacterial defense mechanism that operates by resisting bacterial adherence and infection. The present study further implicates bladder surface glycosaminoglycans as the key antiadherent factor and also suggests a potential model for diseases (such as urinary tract infections) whereby the antiadherent surface of the bladder is inactivated biochemically. Protamine sulfate treatment of bladder tissue was found to significantly increase bacterial adherence to the urinary bladder by approximately 2.3-fold. This effect was reversed by a second treatment of the bladder with pentosanpolysulfate (a polysaccharide known to duplicate the surface antiadherent effect). Protamine sulfate had no effect on bacterial viability or bacterial adherence when bacteria were pretreated with it.
A national survey of testicular cancer documented recent trends in disease characteristics, treatment, and outcome, providing a basis for progress being achieved on a community basis. A long-term study of 3285 patients diagnosed between 1970 and 1975 was compared with a short-term study of 1887 patients diagnosed in 1983. An increase of the symptom of a lump in the testis from 23.1% to 31.2% and a mass as a sign of cancer from 44.5% to 53.8% suggests earlier detection of testis cancer by the patient and physician. Changes in the methods of diagnosis reflect the changing technology of tumor diagnosis. The 10-year survival rates for pathologic Stage I seminoma (82.6% of all seminomas) exceeded 96%. For pathologic Stage I nonseminomatous germ cell tumors (51.7% of all NSGCT), 10-year survival was 87.1%; whereas for Stage III (18.7% of all NSGCT) it was 22.1%. The impact of the important advances in chemotherapy is reflected in the increase of 1-year survival of Stage III NSGCT from 50.5% to 78.4%. Testis cancer can be cured in most patients.
Metastasis from the prostate to the lungs is common; however, endobronchial metastasis from the prostate has been reported only twice. We report a patient with endobronchial metastases from the prostate in the absence of bony metastases. Clinical and roentgenographic findings of pulmonary metastases from prostate cancer are described, and therapeutic considerations are discussed.
Data from a recent survey of patterns of care for prostatic cancer sponsored by the American College of Surgeons suggest several trends compared to similar data from a decade ago. The observed differences include increased diagnosis of localized cancer, and increased use of acid phosphatase determinations, bone scans, radical retropubic prostatectomy, radiotherapy (particularly interstitial techniques) and orchiectomy. In contrast, use of bone surveys, perineal prostatectomy and hormonal therapy has decreased. Transurethral resection continues to be the most common means to establish the diagnosis of prostatic cancer but the data do suggest that in more patients the tumors are being staged and graded. Five-year survival rates appear to be improving for all stages, and for white and black patients. Survival of black patients continues to lag behind that of white subjects, presumably owing to the more advanced stage of disease at diagnosis observed in these data. These findings may have important implications for understanding trends in survival of patients with this disease.
Explore the source record for details and available documents.