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Biomedical subjects

L A Klein

Publications and source records attributed to L A Klein.

At least 19 recordsLinked to original sources
PubMed1989

Embolization of solitary spinal metastases from renal cell carcinoma: alternative therapy for spinal cord or nerve root compression.

Four patients with a solitary vertebral metastasis from a renal cell carcinoma presented with acute spinal cord or nerve root compression. Because of the markedly hypervascular nature of the metastases it was decided to palliate the lesions by transarterial catheter embolization. The embolization reduced the venous blood pool within the tumors, resulting in progressive neurological improvement often lasting for 12 weeks or more. With such palliation, surgical decompression may be obviated, postponed, or at least made manageable.

Aged↗
PubMed1989

Balloon dilatation for prostatic obstruction. Long-term follow-up.

Balloon dilatation of the prostatic urethra may improve the uroflow in patients with benign prostatic hypertrophy (BPH). In this study, patients were assigned blindly for balloon dilatation (5 men) or observation (3 men). A 36F balloon was inflated in the prostatic urethra with local anesthesia and fluoroscopic guidance for thirty minutes. The effects of the procedure were monitored during a two-year follow-up period. Two of the treated patients had improvement in uroflow and experienced stabilization of clinical symptoms. Two had no significant change in uroflow and required prostatectomy within the observation period. One required prostatectomy soon after dilatation. One of the 3 patients in the control group required prostatectomy in the two-year follow-up period and the other 2 continue to have obstructive symptoms. Although dilatation of the prostatic urethra by balloon may relieve some patients of urinary outflow obstruction due to BPH, it appears that a 36F balloon dilator does not produce dramatic or consistent results, and the effects of larger balloons should be evaluated.

Adult↗
PubMed1988

Urge incontinence can be a disease of bladder sensors.

In many cases of urge incontinence the pathophysiology is unclear. Detrusor instability, detrusor hyperreflexia, urethral instability and poor sensory perception all have been suggested as requirements for urge incontinence. Sensory perception, as proposed recently, may be mediated by 2 bladder sensors. The first sensor, located at the trigone and posterior urethra, is sensitive to small changes in pressure and may function as an early warning system of bladder filling. In the diagnostic evaluation of urge incontinence 5 patients had a triad of absence of the first sensor, an intact second sensor, that is the urge to void when the bladder is stretched with fluid, and normal spontaneous detrusor contraction. Based upon these findings it is suggested that some instances of urge incontinence result when the early warning system fails and detrusor contraction occurs just shortly after the second sensor is stimulated. Detrusor instability was identified in 3 of the 5 patients with urge incontinence, and when present it was associated with urinary frequency. Thus, 2 forms of urge incontinence may be associated with loss of the first sensor: 1 with and the other without associated frequency, with the difference being the presence or absence of detrusor instability.

Aged↗
PubMed1987

Signet-ring cell carcinoma of bladder. Evaluation of three cases with review of literature.

Three cases of adenocarcinoma involving the bladder and consisting mainly of signet-ring-shaped cells are presented. Each case represents a different form that the lesion may take, and these forms are compared. This unusual neoplasm has a worse prognosis than transitional cell carcinoma of the bladder, possibly because of factors that lead to delays in management. Radiation therapy is ineffective, and the results of treatment with segmental resection of the involved area of the bladder are equivalent to those of total cystectomy.

Adenocarcinoma, Mucinous↗
PubMed1987

Measurement of trigonal sensitivity as a test of bladder function.

A method has been developed for the measurement of sensory receptors that respond to pressure at the base of the bladder and posterior urethra. The application of force to a balloon catheter placed at that part of the bladder regularly results in an urge to urinate. People with normal voiding perceive the urge to void when 245 +/- 47 gm. (standard deviation) of force are applied. Patients with irritative symptoms (urinary frequency and urgency) perceive the urge to void when 132 +/- 50 gm. (p equals 0.0003) are applied. After enucleative prostatectomy more force is required to cause the urge to void (344 +/- 48 gm., p equals 0.0003) and even more force is required after radical prostatectomy (469 +/- 54 gm., p equals 0.0002). Patients with acute urinary retention or urinary stress incontinence were not distinguishable from the normal group. Patients with chronic urinary retention may be divided into 2 subgroups: 1 with normal sensory perception and 1 with reduced perception (526 +/- 32 gm., p equals 1.6 X 10(-9)). Three patients with urinary urgency not associated with frequency did not perceive the urge to void until 541 +/- 21 gm. (p equals 6.2 X 10(-7)) had been applied. Some elderly patients could not reproducibly report the urge to void. When lidocaine was applied topically within the bladder sensitivity was reduced by 210 +/- 114 gm. (p equals 0.003). It is suggested that pressure sensitive receptors in the mucosa or submucosa of the bladder base and posterior urethra have a role in micturition, that their activity can be quantitated and that protocols designed to manage them may have impact on the care of patients with voiding disorders.

Female↗
PubMed1987

Prostaglandin synthesis is independent of androgen levels in rat male genitalia.

We examined the hypothesis that androgens influence prostaglandin (PG) biosynthesis in rat male genitalia. Prostaglandin synthesis was measured on the basis of the amount of prostaglandin released per unit weight of tissue over time. On this basis, castration increased the synthesis rate of radioimmunoassayable PGE2 from 1.3 +/- 2.5 to 7.4 +/- 2.5 ng/mg protein/180 min (P less than 0.01) in slices of prostate gland, and from 8.5 +/- 1.5 to 24.9 +/- 4.1 ng/mg protein/180 min (P less than 0.01) in slices of seminal vesicle, but decreased PGE2 formation from 27.8 +/- 2.0 to 14.3 +/- 1.2 ng/mg protein/180 min (P less than 0.01) in the vas deferens. Castration had no effect on synthesis of PGE2 in slices of renal cortex or liver. The peak effect of castration for each tissue was variable, ranging from 4 to 14 days. Treatment of castrated animals with testosterone reversed the effect of castration on prostatic prostaglandin biosynthesis: control 1.62 +/- 0.26 ng/mg protein/180 min, castrate 6.05 +/- 1.10 ng/mg protein/180 min, and castrate treated with testosterone T 1.72 +/- 0.16 ng/mg protein/180 min. Testosterone administration also decreased PGE2 formation in normal (noncastrate) animals from 1.62 +/- 0.26 to 0.91 +/- 0.23 ng/mg protein/180 min (P less than 0.04). Similar patterns of stimulation or reduction in biosynthesis of PGF2 alpha and 6-keto-PGF1 alpha were also observed. When considered for the whole gland and not per slice, all the differences disappeared. These results demonstrate that the androgenic effect on the male genitalia occurs in a component of the gland that is unrelated to the production of prostaglandins and that prostaglandin synthesis is maintained despite the occurrence of widespread atrophy.

Androgens↗
PubMed1983

The emergency management of patients with ureteral calculi and fever.

Patients presenting with ureteral calculi and fever were treated with antibiotics, fluids and careful monitoring. An emergency operation or ureteral manipulation was withheld until the patient became afebrile. In 14 patients so treated all became afebrile and 11 required no surgical intervention. It is suggested that carefully monitored resuscitation should precede instrumentation in patients with urinary stones and fever.

Adult↗
PubMed1982

Acute effects of testosterone on serum PGE2 levels in male dogs.

Serum prostaglandin levels are influenced by testosterone. To test the hypothesis that the effect of testosterone is mediated through the prostate gland, testosterone was given acutely to intact and to prostatectomized male dogs. Intact dogs responded to testosterone with an abrupt, transient rise in plasma PGE2 levels; prostatectomized dogs did not respond. We conclude that testosterone has an acute effect on the prostate gland which results in release of PGE2 into the blood stream.

Animals↗
PubMed1982

The comparative medical costs of 2 major procedures available for the treatment of stress urinary incontinence.

Female urinary stress incontinence is a common surgical problem. We reviewed the case records of 71 women who were operated upon for stress incontinence at our medical center from 1975 to 1980. Of these women 30 underwent the Pereyra-Stamey endoscopically controlled suspension of the bladder neck and 41 underwent the Marshall-Marchetti-Krantz repair. We compared the major components of care contributing to the cost of each surgical procedure. At current 1980 prices a significant saving of 4 days in hospital stay and of $2,500 in total medical costs can be effected by choosing the Pereyra-Stamey technique over the Marshall-Marchetti-Krantz procedure. No important differences were noted in complications, operating room time or surgeon's fees.

Boston↗
PubMed1981

Role of acid phosphatase measurement in management of prostate cancer.

Serum acid phosphatase was measured in 155 people of whom 45 had prostate cancer and 110 were either normal or had other conditions. The assay did not discover early cases of prostate cancer but did reveal accurately patients with metastatic prostate cancer. The assay appears to be valuable for the purposes of staging the disease but as a method of discovering patients with early forms of prostate cancer.

Acid Phosphatase↗
PubMed1981

Results of inferior vena cava resection for renal cell carcinoma.

A total of 24 patients with renal cell carcinoma involving the inferior vena cava underwent thoracoabdominal radical nephrectomy with removal of tumor thrombus by an open or closed technique. The tumor extended in the inferior vena cava to the level of the renal or lower hepatic veins in 18 patients and it reached the level of the diaphragm or right atrium in 6. Of the 24 patients 3 with preoperative findings minimally suggestive of disseminated disease were shown later to have metastases in the questionable areas, 3 with disease at the level of the diaphragm had incomplete resections, 4 had metastases to regional lymph nodes and 1 had questionable preoperative findings and lymph node metastases. Only 13 of the 24 patients (54 per cent) did not have either disseminated or residual tumor postoperatively. The mean survival duration of this subgroup (20 months) was comparable to that of the group as a whole (21 months). However, 4 patients from this subgroup are free of disease, with a mean followup of 30 months. There was 1 postoperative death. Morbidity, including renal failure, intraoperative hypotension and sepsis, was common. The results in this series suggest that the prognosis for patients with renal cell carcinoma and inferior vena cava involvement is guarded.

Adenocarcinoma↗
PubMed1980

Postoperative percutaneous kidney stone extraction.

Retained stones may be found in patients who have undergone operations for multiple renal calculi. These stones often produce morbidity and must be removed. The authors describe a technique using a nephrostomy tube, placed during the initial operation, to extract stones percutaneously.

Adult↗