Search PubMed⌕ Search

Biomedical subjects

M B Siroky

Publications and source records attributed to M B Siroky.

16 recordsLinked to original sources
PubMed1992

The role of fine-needle aspiration biopsy of the prostate in staging adenocarcinoma.

Stage A prostate cancer is defined as the incidental finding of cancer in specimens obtained by transurethral resection of the prostate (TURP) in a clinically benign gland. A low-to-moderate grade tumor involving less than 5% of the TURP specimen has been termed Stage A1; a high-grade tumor or tumor involving more than 5% of the TURP specimen is termed Stage A2. Most investigators agree that Stage A1 disease has a significantly better prognosis than Stage A2 disease and may not warrant radical prostatectomy. However, the problem of correctly differentiating A1 and A2 disease remains. The authors prospectively studied 100 consecutive patients undergoing TURP for outlet obstruction without clinical suspicion of prostate cancer by digital examination. Each patient underwent fine-needle aspiration biopsy (FNAB) of each side of the prostate immediately before TURP. These data show that the addition of preprostatectomy FNAB increased the incidence of finding adenocarcinoma of the prostate from 10% to 14%. An additional 3% had FNAB results that were highly suspicious. A positive correlation between cytologic and histologic findings was seen in 83% of patients. Of three patients with Stage A2 prostate cancer, none had malignant cytologic findings. Of seven patients with Stage A1 disease, five (71%) had suspicious or malignant cytologic findings. Seven patients (7%) had suspicious or malignant cytologic findings with no histologic evidence of tumor. In conclusion, preprostatectomy FNAB cannot differentiate Stage A1 from Stage A2 prostate cancer. However, the procedure does increase the yield of finding incidental prostate cancer. The therapy of patients with either (1) malignant cytologic findings alone (Stage A0 disease), or (2) Stage A1 histologic and malignant cytologic findings (Stage A1+) is unclear at present.

Adenocarcinoma↗
PubMed1992

Effect of spinal cord ischemia on vesicourethral function.

We studied 9 patients with clinical evidence of spinal cord ischemia or infarction who had altered vesicourethral function. Of the patients 6 had some preservation of bladder and lower extremity sensation, a clinical pattern consistent with the anterior spinal artery syndrome. A total of 3 patients had a clinical picture more consistent with complete transverse myelopathy, since they had no preservation of bladder or lower extremity sensation. Despite sensory levels well above the sacral spinal cord segments, 6 patients had detrusor areflexia (4 with bethanechol supersensitivity and 4 with neuropathic changes in the perineal electromyograph) indicating longitudinal spinal cord involvement. Three patients had detrusor hyperreflexia with vesicosphincter dyssynergia, indicating some preservation of the sacral spinal cord. In 6 patients appreciation of pinprick in the lower extremities was absent or decreased but light touch or position sense was preserved. Bladder sensation was dissociated in 4 of these 6 patients, since they had perception of bladder distention but loss of urge to void. These findings indicate that bladder distention is a sensory modality probably mediated via the posterior spinal cord, while the sense of urgency is probably conveyed by the anterior spinal cord.

Adolescent↗
PubMed1991

Adrenal hemangioma: an unusual adrenal mass delineated with magnetic resonance imaging.

Adrenal hemangioma should be included in the differential diagnosis of any large calcified adrenal mass. We report to our knowledge the eighth surgically removed lesion and describe its appearance on magnetic resonance imaging. This imaging includes features seen in hemangiomas elsewhere, in particular a heterogeneous mass with enhancing peripheral high intensity foci on T1 images.

Adrenal Gland Neoplasms↗
PubMed1991

Acquired renal cystic disease: implications for the urologist.

Acquired cystic kidney disease has become increasingly recognised as a significant risk in patients with end-stage renal disease, especially in those maintained on chronic haemodialysis and peritoneal dialysis. A review of the literature indicates that nearly 50% of patients on dialysis for more than 3 years develop renal cystic changes. The major complications of this condition are neoplasia and spontaneous renal haemorrhage. The risk of developing renal carcinoma has been estimated to be more than 30 times higher in dialysis patients with cystic changes than in the general population. Our experience with 5 patients is reported, including 3 with renal tumours and 1 with metastatic disease. Careful surveillance of dialysis patients using yearly ultrasonography and computed tomography is recommended. The evolving indications for radical nephrectomy in this disease are discussed.

Female↗
PubMed1990

Hemodynamics of pelvic nerve induced erection in a canine model. I. Pressure and flow.

Using a previously developed canine model of erection, we measured pudendal artery and venous flow as well as pressure in the corpora cavernosa, glans penis, pudendal artery and vein. Penile erection was induced by pelvic nerve stimulation. Arterial flow increased by a factor of 2.5 within two seconds after the onset of stimulation. This was followed by a similar increase in venous flow about one second later. Spongiosal pressure began to rise about six seconds after nerve stimulation and always remained below cavernosal pressure. Cavernosal pressure began to rise after a latency of about 11 seconds. This latency period is accounted for by relaxation of the smooth muscle of the cavernosal sinusoids. Spongiosal pressure is maintained primarily by a high flow state through the glans penis while cavernosal pressure depends on a veno-occlusive mechanism.

Animals↗
PubMed1990

Duraphase penile prosthesis--results of clinical trials in 63 patients.

The Duraphase penile prosthesis was implanted in 63 patients at 4 investigative sites during clinical trials. This device is a semirigid rod that is bendable and provides good support to the erection. Mechanical complications included 4 instances of cable breakage rendering the device nonfunctional. Of 57 patients questioned 55 were pleased with the results after 4 months. Ease of insertion and exceptional bendability are other features that make this device attractive.

Adult↗
PubMed1990

Interpretation of urinary flow rates.

The uroflow examination is the most accurate, physiologic, and noninvasive method of assessing bladder outflow obstruction. The examiner must be aware of the errors that may arise from problems inherent in the uroflowmeter, in the patient (such as psychological inhibition), or in bladder physiology (such as the influence of intravesical volume). Additional tests such as pressure-flow studies or simple cystometry are required in certain cases.

Female↗
PubMed1989

Expanded role for fine needle aspiration of the prostate. A study of 335 specimens.

In 279 patients, 335 cytologic samples were obtained from the prostate and correlated with histology obtained by core needle biopsy in 189 cases. Approximately 6% of the cytologic specimens were inadequate for diagnosis. The unconfirmed positive rate for malignancy was 1.6%, the false-negative rate was 27.9%, and the accuracy rate was 89.6%. Granulomatous inflammation was diagnosed in 19 cases, and three cases of tumors other than acinar carcinoma of the prostate were encountered. Based on our experience, cytologic criteria for the diagnosis of prostatic adenocarcinoma are described.

Adenocarcinoma↗
PubMed1988

Post-prostatectomy continence in the parkinsonian patient: the significance of poor voluntary sphincter control.

A retrospective urodynamic study of 50 parkinsonian patients was done to determine the incidence and causes of post-prostatectomy incontinence. At presentation 22 per cent of the patients were incontinent. In 36 patients who underwent transurethral prostatectomy the incontinence rate was 17 per cent preoperatively and 28 per cent postoperatively. There was a clear association between normal voluntary sphincter control and urinary continence. After transurethral prostatectomy 5 of 6 patients continent preoperatively (83 per cent) who had abnormal sphincter control became incontinent compared to 1 of 24 (4.2 per cent) who had normal sphincter control. We conclude that the major risk of incontinence following prostatectomy in the parkinsonian patient is associated with lack of voluntary sphincter control.

Aged↗
PubMed1985

Vesico-urethral function in Huntington's chorea.

Six patients with Huntington's chorea (5 females, 1 male) underwent neuro-urological evaluation because of urological complaints, usually incontinence. Four patients had detrusor hyperreflexia with a normal sphincter and two patients had a normal study, suggesting that their incontinence might be non-organic. A characteristic urodynamic pattern, not previously described, was observed, consisting of choreiform contractions of the abdominal perineal floor muscles during filling with selective suppression of choreiform contractions in the perineum during detrusor contraction.

Adult↗
PubMed1979

Sacral signal tracing: the electrophysiology of the bulbocavernosus reflex.

We studied 52 men with electrophysiologic testing of the bulbocavernosus reflex to determine reflex latency. The bulbocavernosus reflex was demonstrated to be a segmental polysynaptic reflex with cross-over in the sacral spinal cord. Excellent correlation was obtained between prolonged latency and clinical evidence of neuropathy. The examination may be useful clinically to evaluate patients suspected to have sacral cord lesions or pudendal neuropathy (for example impotence, chronic back pain and lesions of the cauda equina and peripheral nerves).

Adult↗
PubMed1979

The flow rate nomogram: I. Development.

In normal individuals the flow rate depends on the initial bladder volume in a non-linear fashion. A flow rate nomogram taking this relationship into account was developed as an aid in the interpretation of urinary flow rate data. With this approach excellent differentiation of normal from obstructed individuals was achieved. In addition, the variability in a single individual's flow rate over time was estimated to be relatively small and, thus, uroflowmetry may be used to identify changes in outflow resistance after medical or surgical therapy.

Adult↗
PubMed1977

The phentolamine test in neurogenic bladder dysfunction.

In an attempt to improve the selection of patients with neurogenic bladder dysfunction likely to benefit from phenoxybenzamine therapy, the effect of intravenous phentolamine (Regitine) on the urinary flow rate was determined in normal and abnormal subjects. A nomogram relating mean flow rate to volume voided was constructed to aid in the interpretation of results. In 16 patients with neurogenic bladder dysfunction it was found that a response of more than 0.8 nomogram units indicates a likelihood of clinical improvement with phenoxybenzamine therapy. The clinical applications of this test are discussed.

Adult↗
PubMed1976

Metastatic infection secondary to genitourinary tract sepsis.

Metastatic infections arising from sepsis in the genitourinary tract are reviewed in 175 cases, including five in which we treated the patients. The skeleton was the most common site of metastasis (59 per cent). The endocardium was next most frequently involved (28 per cent). Gram-negative organisms were implicated in less than two-thirds of the cases (59 per cent). Impaired host defense mechanisms were noted in 25 per cent of the patients experiencing metastatic infections. The lower urinary tract was the source of metastasis in 75 per cent of the patients, particularly after urologic manipulation in men. Women were more likely to experience metastatic infection from the upper urinary tract. Anatomic and pathologic considerations explaining these sex differences are presented.

Aged↗