Biomedical subjects
J J Kaufman
Publications and source records attributed to J J Kaufman.
Non-invasive low-intensity pulsed ultrasound accelerates bone healing in the rabbit.
The effect of ultrasound (US) on the rate of fibula osteotomy healing in 139 mature New Zealand white rabbits was assessed in this study. Bilateral midshaft fibular osteotomies were made using a 1-mm Gigli saw. US was noninvasively applied to one limb for 20 minutes daily, while the contralateral limb served as a control. A 2.5-cm PZT transducer was applied to both limbs, with the treated limb receiving a 200-microseconds burst of 1.5-MHz sine waves repeated at 1.0 kHz. The incident intensity was approximately 30 mW/cm2. Animals were killed at intervals between 14 and 28 days. Maximum strength increases (significant to p less than or equal to 0.01) ranged from 40 to 85% from postoperative day 14 to 23. On day 28, no significant difference in ultimate strength was noted. From day 17 through day 28, all US-treated fractures were as strong as intact bones (p less than or equal to 0.005). On the other hand, the ultimate strength of the control osteotomies attained intact values only by day 28. These results indicate that biomechanical healing is accelerated by a factor of nearly 1.7. This occurs with an overall acceleration of the healing curve in this fresh fracture model. If noninvasive low-intensity pulsed sine wave ultrasound can significantly accelerate bone repair in clinical application with an in-home treatment of 20 minutes daily, then US may be a useful adjunct for fracture care with a concomitant impact on patient morbidity.
Successful use of transureteroureterostomy to salvage ureterosigmoidostomy after anastomotic failure.
Four cases are presented of patients who had undergone ureterosigmoidostomy and in whom a unilateral ureteral anastomotic complication developed that was salvaged subsequently by a transureteroureterostomy. Although other forms of urinary diversion are now being utilized routinely in many centers, the ureterosigmoidostomy is still being employed worldwide, and urologic surgeons need to be versed in its potential problems and how to correct them.
Unique urinary-fecal calculus after cystectomy and ureterosigmoidostomy.
A 36-year-old m an had stage B1 bladder cancer-treated by cystectomy and ureterosigmoidostomy. Postoperatively, a urinary leak was managed successfully by transureteroureterostomy and temporary colostomy. In succeeding years a large calculus developed in the region where the bladder had been and it also involved the sigmoid colon. The huge stone was removed successfully. A nonabsorbable suture was found in the center of the stone. This is a unique complication of ureterosigmoidostomy.
Urethral gap in complete disruption of membranous urethra.
In patients with complete disruption of the membranous urethra treated initially with placement of a suprapubic cystostomy, delayed synchronous retrograde and voiding cystourethrograms failed to demonstrate accurately the distance between the two urethral ends. Radiographic exposure obtained during synchronous instrumentation of the anterior and posterior urethra in the anesthetized patient was the most precise method of defining the extent of the urethral gap. Any surgical decision should be based on this type of investigation. In most cases of pelvic crush injuries, the severed membranous urethra probably remains attached in close proximity to the distal segment, thus directing the redescent of the prostate and bladder base in the presence of a contracting pelvic hematoma.
The effect of verapamil in reducing the severity of acute tubular necrosis in canine renal autotransplants.
Calcium channel blockade has been shown to prevent warm renal ischemic damage. The ability of verapamil to decrease the severity of acute tubular necrosis (ATN) after 24-hr cold storage and autotransplantation was studied in a randomized paired study of 12 dogs. Experimental animals pretreated with intraarterial verapamil and flushing of the harvested kidney with cold intracellular solution containing verapamil demonstrated significantly (P less than .05) greater renal function preservation over their matched controls. A subsequent nonpaired study of 6 dogs treated only with flushing of the harvested kidney with perfusate containing verapamil demonstrated no significant preservation advantage over controls. We conclude that verapamil, administered prior to the ischemic event, can enhance the protective effect of hypothermia and decrease the severity of ATN in ischemically injured kidneys.
Nephrocolic fistula: a complication of percutaneous nephrostolithotomy.
Percutaneous nephrostolithotomy has proved to be a safe and effective approach to the management of upper tract calculi, which is associated with a low rate of significant complications. Bowel perforation is an unusual complication of this technique. We report a case of a nephrocolic fistula following percutaneous nephrostolithotomy, and discuss the diagnosis and management of this rare complication.
Fine needle aspiration biopsy of the prostate gland: a study of 103 cases with histological followup.
Fine needle aspiration specimens of the prostate gland were compared to histological material in 103 patients. The sensitivity was 95 per cent, specificity 97 per cent and efficiency 87 per cent. Initial core needle biopsy compared to the final histological diagnosis in this study had a sensitivity of 76 per cent, specificity 100 per cent and efficiency 71 per cent. Fine needle aspiration by a well trained cytopathologist is less traumatic, and has fewer side effects and a higher sensitivity rate than conventional core needle biopsy.
The Kock pouch as a urinary reservoir. Pitfalls and perspectives.
The Kock continent urinary reservoir is a feasible alternative to traditional methods of urinary diversion in properly motivated patients who are anxious to exchange a convenient external appliance for frequent reservoir catheterization. The major shortcomings are increased operative time, loss of a long segment of small bowel, and an approximate 10 percent incidence of major reoperation. Long-term results are unknown. Facility with the operation requires extensive experience and attention to detail. Most complications are related to inadequate fixation of the intussuscepted valves and improper placement of a short terminal segment in the abdominal wall. Early repair of malfunctioning valves and distal segments that are difficult to catheterize is essential to prevent more severe acute complications. Whether the Kock pouch will replace the standard methods of urinary diversion must be determined by more extensive clinical experience and long-term results.
Result of treatment of patients with stage D1 prostatic carcinoma.
Between 1972 and 1982, 59 patients who had documented pelvic lymph node metastases, proved by pelvic lymphadenectomy, were available for analysis. Radical retropubic prostatectomy was the primary treatment in 33 patients with or without other therapies, while 23 patients received external beam radiation therapy as their primary treatment. Three patients received hormonal therapy alone. Forty-two of 59 patients are alive for a crude survival of 71 per cent. Sixteen patients have died of metastases. Patients with low-grade tumors, small tumor burden, and limited lymph node metastases had excellent short-term survival after radical prostatectomy.
Primary carcinoid tumor of testis with metastasis.
A primary carcinoid tumor of the testis metastatic to one preaortic lymph node in a forty-three-year-old man is reported. The case was of great clinical interest not only because of the extreme rarity of testicular carcinoid with metastasis but also because of a coincidental bacterial endocarditis.
The use of collagenase in the treatment of Peyronie's disease.
Purified clostridial collagenase was administered intralesionally in 31 men with Peyronie's disease. Within 4 weeks of treatment 20 patients showed an objective improvement. Pain was eliminated in 13 of 14 patients with this complaint at presentation within the same 4-week period. The ability to have intercourse was restored in 3 of 4 patients with this problem. Except for a small corporeal rupture at the site of injection in 1 patient, no significant untoward effects were noted. During the mean 9.8-month followup 1 recurrence of bending was noted.
The management of superficial bladder tumors and carcinoma in situ with intravesical bacillus Calmette-Guerin.
A phase II study was performed to assess the role of bacillus Calmette-Guerin as a prophylaxis against recurrent stages O and A bladder tumors, and in the treatment of existing superficial bladder tumors and carcinoma in situ. Tice strain bacillus Calmette-Guerin (1 vial, 2 to 8 times 10(8) organisms in 60 cc saline) was instilled intravesically without cutaneous inoculation. Instillations were given weekly for 6 weeks and then monthly or until recurrence in 22 patients with a history of recurrent tumors, while 22 with existing stages O and A transitional cell carcinoma, and 19 with carcinoma in situ were treated weekly for 8 weeks and then monthly for 12 months or until failure. Complications included cystitis in 88 per cent of the patients (severe in 20 per cent), fever in 15 per cent, a flu-like syndrome in 13 per cent, edema and pruritus in 1.5 per cent, and ureteral stenosis in 1.5 per cent. Twelve patients (19 per cent) did not complete the study owing to toxicity. Of the patients in the prophylaxis group 67 per cent have had no tumor recurrence 10 to 26 months (mean 15 months) after therapy. Of the patients with existing tumors 36 per cent had complete regression following bacillus Calmette-Guerin therapy and 23 per cent had a partial response. Among the patients with carcinoma in situ 13 (68 per cent) had reversal to normal urothelium and 3 (16 per cent) had marked improvement. None of the patients had recurrence at 11 to 20 months. Intravesical Tice strain bacillus Calmette-Guerin is effective as a prophylaxis against recurrent superficial bladder tumors and in the treatment of carcinoma in situ.
Spontaneous perinephric hemorrhage in a 65-year-old man.
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Quantum chemical and other theoretical studies of carcinogens, their metabolic activation and attack on DNA constituents.
We have carried out a variety of different types of studies on carcinogens: ab-initio quantum chemical, including generation of electrostatic molecular potential contour (EMPC) maps and graph theoretical generation of polycyclic aromatic hydrocarbon (PAH) structures and characterization of the "carcinogenic" bay regions. Polycyclic aromatic hydrocarbon (PAH) carcinogens are activated metabolically from precarcinogen (PAH's) through proximate carcinogens (PAH epoxides and dihydrodiols) to ultimate carcinogens (PAH dihydrodiolepoxides) which then attack DNA constituents. We carried out ab-initio MODPOT/VRDDO/MERGE calculations on a variety of these molecules using our own ab-initio programs which incorporate as options a number of desirable options for ab-initio calculation on large molecules. From these electronic wave functions, we generated electrostatic molecular potential contour (EMPC) maps around these molecules. These EMPC maps indicated predictively the positions at which epoxides would form and the propensity and geometrical preference to form dihydrodiols and dihydrodiolepoxides. We performed spin and symmetry analyses for attack of O adding across C = C bonds or inserting in C-H or N-H bonds. We also carried out ab-initio calculations for attack of ultimate carcinogens on DNA constituents. Using graph theory we generated all possible structures for any arbitrary numbers of aromatic rings and also set up a graph theoretical characterization of the "carcinogenic" bay region. Most recently, we have incorporated this into a computer program for global prediction of toxicity.
"O" ring urinary ostomy appliance.
A non-adhesive urostomy system represents a major departure from ostomy appliances that have been used to date. Experience of 123 ostomates who have lived with the traditional as well as the new appliance indicates a high degree of patient acceptance and satisfaction. The "O" ring appliance promises to simplify and improve the quality of life for patients who are committed to this form of urinary disposition.
Bilateral renal cell carcinoma and renal cell carcinoma in the solitary kidney.
We report on 43 patients with renal cell carcinoma in a solitary kidney, 39 of whom underwent a potentially curative resection. Of 36 patients who had a nephron salvaging procedure only 4 required ex vivo surgical resection. The survival curves of patients with solitary or bilateral lesions are similar, and depend more on the adequacy of tumor resection and tumor stage than on the fate of the contralateral kidney. Crude survival in this series was 64 per cent for patients followed for more than 1 year.
Radiation therapy in carcinoma of the prostate: a contributing cause of urinary incontinence.
We believe that radiation therapy as a postoperative adjuvant or preceding salvage prostatectomy for carcinoma is particularly conducive to the complication of urinary incontinence by virtue of its sclerosing effect on residual sphincter mechanisms. Obviously, such dual therapy will continue to prevail in the foreseeable future but patients should be notified of the added risk and be prepared for further treatment of the incontinence. Unfortunately, these patients have an extra risk of complications and failure from anti-incontinence operations.