Biomedical subjects
Publications and source records attributed to L H Finkelstein.
The metastatic sites of adenocarcinoma of the prostate are well documented. Bone metastasis is the most frequently encountered site. Skin metastasis is rarely reported. Its presence, however, is associated with a poor prognosis. The possible cause of cutaneous spread is discussed in the case report. The possible role that external-beam radiotherapy may play in this setting is also analyzed.
Ceftriaxone (1 g, intravenous administration, 30 to 60 minutes preoperatively) was the only antimicrobial therapy used for 103 male patients undergoing transurethral surgery. Only patients who had sterile urine were included in the study. Patients with a preoperative catheter placed were excluded. One transurethral incision of the prostate, four direct-vision internal urethrotomies, and 98 transurethral resections of the prostate were performed. Urine specimens for culture were obtained preoperatively and on first voiding after catheter removal for all patients. During the first postoperative visit (11 to 40 days after surgery), urinalysis was performed for all patients, and specimens for culture were obtained from 89 patients. No infections were noted on cultures of first voided specimens after catheter removal; there were four infections (3.88%) on first postoperative visit cultures. No significant morbidity occurred secondary to urinary tract infection. According to these findings, the use of antimicrobial agents beyond the preoperative and immediate postoperative period in uninfected patients undergoing transurethral surgery does not appear to be indicated.
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Electroresection of the prostate followed by Nd-YAG laser coagulation of residual prostate was carried out in eight dogs. All dogs voided spontaneously without significant bleeding in the immediate postoperative period. At the time of sacrifice in 6 to 8 weeks, no damage to adjacent tissue was seen on microscopic examination. Re-epithelization had occurred. This study suggests that the addition of neodymium-YAG coagulation to residual tissue after TURP in humans can be done safely.
One hundred twenty-nine patients undergoing transurethral resection of the prostate were treated preoperatively with either 1 g of ceftriaxone or placebo in a double-blind, randomized study. Sixty-three patients received placebo and 66 received ceftriaxone. Postoperative urinary tract infections developed in eight placebo-treated patients, for a 12.7 percent failure rate, compared with two ceftriaxone-treated patients, for a 3 percent failure rate. The difference in rates of infection was statistically significant (p less than 0.05). No adverse effects due to treatment were noted. The high rate of postoperative infection in the placebo-treated group indicates that maintenance of sterility during and after this operative procedure is a problem. A single 1 g prophylactic preoperative dose of ceftriaxone was safe and efficacious in reducing the rate of postoperative infection after transurethral resection of the prostate.
The characteristics, advantages, and disadvantages of the CO2 laser to various clinical situations in urologic surgery are described and evaluated. Conditions treated routinely with the laser are presented and future possible uses discussed.
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