Biomedical subjects

M I Resnick

Publications and source records attributed to M I Resnick.

At least 37 records · Page 2Linked to original sources

PubMed2000

Analysis of recent trends in prostate cancer incidence and mortality.

BACKGROUND: There is debate over whether the recent increases seen in prostate cancer are due to lead-time bias from screening, or identification of clinically insignificant lesions. METHODS: Population-based incidence rates for 1973-1996 were calculated, based on the Surveillance, Epidemiology, and End Results Program (SEER) tumor registries. Relative incidence rates for prostate cancer by stage, fatal incidence, and lymph nodes were calculated, adjusted for age. RESULTS: Localized and regional stage prostate cancer increased through 1992 and then dropped. The rate of distant-stage disease was relatively stable from 1973-1991, with a decrease in distant stage starting in 1992. The 2-year mortality rates were constant for 1973-1989. A decline in the 2-year mortality among cases (fatal incidence) also began in 1992. CONCLUSIONS: These data show large increases in early disease, followed by a drop and leveling off along with a decrease in advanced disease (distant stage, 2-year mortality, positive lymph nodes). This indicates that the increasing incidence rates for prostate cancer are largely due to lead-time bias from increased early detection and treatment of prostate cancer. However, since incidence rates have not declined to rates seen in the 1970s, the additional cases may also reflect length bias from insignificant lesions or a true increase in incidence over time.

Humans↗

PubMed2000

Changing times.

Explore the source record for details and available documents.

Humans↗

PubMed2000

Medical therapy and new approaches to management of urolithiasis.

A simple, step-by-step approach to diagnosis and medical treatment of stone disease is described. It uses urinary stone risk profile obtained before and after dietary modification, history, and minimum diagnostic tests. For each abnormal stone risk factor, potential causes are discussed and treatment options are presented. The article concludes with diagnosis and treatment of combined disturbances.

Calcium↗

PubMed2000

Is there a role for open stone surgery?

Modern day urinary-stone treatment involves procedures and techniques that were not even available 20 years ago. The relatively rapid and sometimes explosive development of ESWL, percutaneous techniques, and ureteroscopy and intracorporeal lithotripsy has ushered in the era of minimally invasive stone management. In many regards, open surgery has such a limited role that its performance often is regarded as a sign of failure. To think of open stone surgery in this manner is likely to do a disservice to a small but important segment of the urinary-stone patient population. The critical responsibility of the urologist treating stone disease is to be able to recognize those clinical situations in which open stone surgery may represent at least a viable and reasonable alternative to less-invasive modalities. The duty of the surgeon is then to be able to present this option to the patient in an unbiased fashion and to effectively perform and implement this form of treatment if chosen. It is only with this approach that open surgery will continue to be correctly applied on those rare occasions and will not become a lost surgical art in the era of minimally invasive surgery.

Humans↗

PubMed2000

Sildenafil and the Internet.

PURPOSE: The Internet is changing the way medicine is being practiced and challenging our notions of the doctor-patient relationship. We analyze the development of online prescriptions and propose guidelines for the sale of sildenafil over the Internet. MATERIALS AND METHODS: Using MEDLINE, Medscape and Lexis-Nexis search engines we reviewed pertinent materials from January 1996 to July 1999 focusing on the keywords Viagra, prescription and Internet. The review included press releases, law review articles, case law, medical literature, pending litigation, proposed legislation, and federal and state statutes. RESULTS: Online prescriptions are an outgrowth of the mail order drug business. This development continues the historic innovations in communications and transportation that have enabled physicians to practice medicine over long distances while maintaining ties to hospitals and other specialists. While the sale of sildenafil over the Internet may be profitable and convenient, it raises a variety of legal, ethical and safety concerns. Many federal and state organizations have addressed the issue without establishing a clear standard. CONCLUSIONS: A clear distinction exists between online prescriptions and pharmacies. While it may be acceptable for sildenafil to be sold over the Internet given current technologies, it must be done within the confines of a traditional doctor-patient relationship. Online prescriptions must be limited to patients who live in states in which the prescribing physician is licensed. Failure to establish a doctor patient relationship in this context breeches ethical standards, and may give rise to potential civil and criminal liabilities.

Erectile Dysfunction↗

PubMed2000

Limitations of computerized tomography in staging invasive bladder cancer before radical cystectomy.

PURPOSE: Computerized tomography (CT) of the abdomen and pelvis is often routine in the preoperative staging assessment of invasive transitional cell carcinoma of the bladder. We determine the accuracy of staging CT findings, usefulness before planned extirpative surgery and impact on surgical management of this disease. MATERIALS AND METHODS: We retrospectively reviewed the medical records, including radiographic, operative and pathological reports, of 82 consecutive cases. All patients presented with muscle invasive bladder tumors, were considered candidates for radical cystectomy and underwent preoperative staging CT of the abdomen and pelvis between July 1994 and June 1998. The ability of CT to provide additional staging information in terms of depth of tumor invasion, local extent of tumor, pelvic lymph node involvement and distant metastases was examined. We determined whether CT findings altered surgical management for individual patients. RESULTS: CT was able to discriminate depth of invasion in only 1 patient (1.2%) and correctly identified extravesical tumor spread in 4 (4.9%). Lymph node and distant metastases were accurately determined in 4 (4.9%) and 2 (2.4%) cases, respectively. The overall accuracy of CT was 54. 9%, with an under staging and over staging rate of 39.0% and 6.1%, respectively. CT provided accurate, additional staging information in only 8 cases (9.8%). Surgical management was altered in 3 cases (3.7%) and only 1 (1.2%) avoided an unnecessary operation as a result of CT findings. CONCLUSIONS: Staging CT of the abdomen and pelvis in patients with invasive bladder carcinoma has limited accuracy, mainly because of its inability to detect microscopic or small volume extravesical tumor extension and lymph node metastases. CT tends to under stage advanced disease and failed to alter surgical management in nearly all of our cases.

Aged↗

PubMed2000

Neoadjuvant hormonal ablative therapy before radical prostatectomy: a review. Is it indicated?

PURPOSE: Neoadjuvant hormonal ablation therapy has been used to decrease the rate of positive surgical margins in patients treated with radical prostatectomy. We reviewed the available literature to determine whether this therapy is indicated and beneficial. MATERIALS AND METHODS: We performed a MEDLINE key word search and assessed randomized prospective articles. Data were analyzed for the rate of positive surgical margins, seminal vesicle invasion and lymph node metastasis as well as surgical characteristics, including operative time, blood loss, hospital stay, rate of complications and difficulty of surgical dissection. In addition, these data were evaluated for prostate specific antigen-free survival. RESULTS: Neoadjuvant hormonal therapy decreased the rate of positive margins in 6 of the 7 randomized prospective studies. In none of 4 randomized prospective series was there an improved rate of seminal vesicle invasion with neoadjuvant hormonal therapy. Of 4 studies 3 showed no improvement in the rate of lymph node metastasis after neoadjuvant hormonal therapy compared with that in controls. Similarly there was no improvement in prostate specific antigen-free survival and no significant difference in operative time, operative blood loss, transfusion or hospital stay in patients treated with neoadjuvant hormonal therapy and controls. In addition, in 2 of 3 studies there was no difference in the complication rate. CONCLUSIONS: Analysis of the available literature revealed no significant improvement in outcome to support the routine administration of neoadjuvant hormonal therapy before prostatectomy.

Androgen Antagonists↗

PubMed2000