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Biomedical subjects

M I Resnick

Publications and source records attributed to M I Resnick.

At least 73 records · Page 4Linked to original sources
PubMed1999

Postmortem sperm procurement: a legal perspective.

PURPOSE: Postmortem sperm procurement with subsequent artificial insemination has become a technically feasible method for posthumous conception. A variety of legal questions exist involving the rights and relationships of the deceased, his family and his issue. We addressed these questions and designed a workable protocol for postmortem sperm procurement. MATERIALS AND METHODS: MEDLINE, WESTLAW and LEXIS medical literature, and case law searches were conducted. United States and international case law, United States (federal and state) statutes, Uniform Law Commissions Acts, and law review commentaries and articles were reviewed. RESULTS: While postmortem sperm procurement is being requested throughout the United States, no standard protocol or procedural guidelines have been established by federal or state statute. Furthermore, the courts have not yet addressed this specific scenario in reported case law. Statutes and case law do address related factual scenarios and issues, including property rights in human bodies, rules governing transplantation of human organs/body parts, rights of parties in in vivo sperm bank donations and responsibilities of parents to the conceptus of artificial insemination. CONCLUSIONS: A workable protocol can be established by analyzing case law and statutes addressing factually similar scenarios. Urologists must focus on the express intent of the decedent and limit any postmortem sperm retrieval to the specific requests made by the decedent. Decedent requests should be documented in writing. The decedent must be competent and of majority age. In the absence of decedent expressed affirmative directive calling for sperm retrieval, no other relative or guardian may authorize this retrieval. Issues regarding the legitimacy and inheritance rights of the conceptus will most consistently be addressed when explicitly provided for in the will of the decedent.

Cadaver↗
PubMed1999

Have complication rates decreased after treatment for localized prostate cancer?

PURPOSE: The American Urological Association Prostate Cancer Clinical Guidelines Panel reviewed 12,501 publications on prostate cancer from 1955 to 1992 to determine whether the complication rates of external beam radiation therapy, interstitial radiotherapy and radical prostatectomy have decreased. MATERIALS AND METHODS: Complications reported in at least 6 series, study duration and sample sizes were extracted. Year specific study weighted mean patient ages and complication rates were computed. Regression analysis was performed of the study year on weighted mean patient age and complication rate. RESULTS: Study year had a significant effect on mean patient age and rate of the majority of complications examined. Data indicated a gradual increase in study patient age and a simultaneous decrease in complications from 1960 to 1990. CONCLUSIONS: Complication rates in the treatment of localized prostate cancer have decreased during the last 20 to 40 years. This decrease occurred despite evidence that the average age of treated patients had increased during the same period.

Aged↗
PubMed1999

A meta-analysis of risk estimates for prostate cancer related to tire and rubber manufacturing operations.

Studies investigating the association between prostate cancer and exposure to the tire and rubber manufacturing environment have reported weak and inconsistent results. A meta-analysis of nine cohort studies that used standard mortality ratios and three case-control studies that used odds ratios was conducted. The pooled results from the nine cohort studies showed a standard mortality ratio of 101 (95% confidence interval [CI] = 93,110), whereas the pooled results from the three case-control studies showed on odds ratio of 1.10 (95% CI = 0.94, 1.29). The standard mortality ratios were converted to odds ratios by dividing by 100. The overall pooled risk estimate from all 12 studies was 1.03 (95% CI = 0.96, 1.11). The conclusion of this meta-analysis is that work exposure in a rubber and tire manufacturing environment does not result in an increased risk of prostate cancer.

Adult↗
PubMed1999

Overexpression of ornithine decarboxylase in prostate cancer and prostatic fluid in humans.

Prostate cancer (PCA), the most commonly diagnosed cancer in males in the United States, is the second leading cause of cancer-related deaths of males in this country. Because of the poor success rate in the treatment of PCA, an intervention at an early stage may reduce the progression of small carcinoma to large metastatic lesion, thereby reducing PCA-related deaths. Concerted efforts are needed to establish mechanism-based approaches to develop: (a) the markers for early detection of the disease as well as toward monitoring the efficacy of treatment(s); and (b) novel chemopreventive strategies against PCA. Using unique samples of pair-matched benign and cancer tissue obtained from the same PCA patient, we showed that ornithine decarboxylase (ODC) activity is significantly (P < 0.001) elevated in PCA (1142 +/- 100; mean +/- SE) than in paired benign tissue (427 +/- 51; mean +/- SE). The immunoblot analysis also showed a significant elevation in the protein expression of ODC in the PCA tissues as compared with the paired benign tissue. Furthermore, our data showed that the ODC activity in the prostatic fluid obtained by a digital rectal massage from the patients with PCA (3847 +/- 162; mean +/- SE) was significantly higher than in the patients with benign prostatic hyperplasia (2742 +/- 167; mean +/- SE) or normal individuals (1244 +/- 67; mean +/- SE). This observation might be of significance because the prostatic fluid could be obtained noninvasively by digital rectal massage. We suggest that ODC could serve as a target for early detection of human PCA as well as for monitoring the efficacy of treatment(s). The development of ODC as a target for novel chemopreventive strategies against PCA is an intriguing possibility.

Biomarkers↗
PubMed1998

Altered expression of RET proto-oncogene product in prostatic intraepithelial neoplasia and prostate cancer.

BACKGROUND: The RET proto-oncogene encodes a protein that belongs to the tyrosine kinase growth factor receptor family. Germline point mutations in RET are found in individuals with multiple endocrine neoplasia (MEN) syndromes, and gene rearrangements have been reported in papillary thyroid cancers. We recently identified transcripts of the RET proto-oncogene in human prostate cancer xenografts and prostate cancer cell lines by means of reverse transcription-polymerase chain reaction analyses. The purpose of this study was to investigate Ret protein expression in human prostate tissue. METHODS: Ret protein expression was evaluated immunohistochemically in formalin-fixed, paraffin-embedded whole-prostate sections. The prostate specimens were obtained from 30 patients with prostate cancer after radical prostatectomies. Ret protein expression was compared in tumor foci and benign prostatic tissue. Medullary thyroid carcinoma tissue associated with an MEN syndrome and papillary thyroid cancer tissue served as positive controls. RESULTS: Ret appeared to be overexpressed in high-grade (histopathologically advanced) prostatic intraepithelial neoplasia (PIN) and prostate cancer when compared with its expression level in benign prostatic secretory epithelium. In addition, there was an apparent increase in Ret protein expression with decreased cellular differentiation, i.e., increasing Gleason pattern. CONCLUSION: Expression of the RET proto-oncogene in benign prostatic epithelium, high-grade PIN, and histopathologically advanced prostate cancer suggests that RET may play a role in the growth of both benign and neoplastic prostate epithelial cells.

Drosophila Proteins↗
PubMed1998

Current indications for open stone surgery in the treatment of renal and ureteral calculi.

PURPOSE: The development and advances in extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open surgery in the treatment of renal and ureteral stones. We reviewed our experience with open stone surgery to determine the current indications and efficacy of this treatment modality. MATERIALS AND METHODS: Hospital and office charts, operative notes and records, and pertinent radiographic studies of all patients undergoing open stone surgery from January 1991 through December 1995 at 3 university affiliated hospitals were reviewed. Patient characteristics, stone burden, indications, surgical factors and outcomes were reviewed for each patient. RESULTS: Of 780 procedures performed for stone removal, 42 were open surgical procedures (5.4%) including pyelolithotomy in 15 (extended pyelolithotomy or pyelonephrolithotomy in 7), anatrophic nephrolithotomy in 14, ureterolithotomy in 7 and radial nephrolithotomy in 6. There were 24 men and 18 women ranging in age from 1 to 90 years (mean age 51.5). The most common indications for open surgery were complex stone burden (55%); failure of extracorporeal shock wave lithotripsy or endourological treatment (29%); anatomic abnormalities such as ureteropelvic junction obstruction, infundibular stenosis and/or renal caliceal diverticulum (24%); morbid obesity (10%) and co-morbid medical disease (7%). Mean estimated blood loss was 428 cc. Average hospital stay was 6.4 days. The stone-free rate after surgery was 93%. Five patients had minor postoperative complications that resolved with appropriate therapy. CONCLUSIONS: While most patients with renal and ureteral stones can be treated with less invasive techniques, open stone surgery continues to represent a reasonable alternative for a small segment of the urinary stone population.

Adolescent↗
PubMed1998

Ureteropelvic junction obstruction and renal calculi. Pathophysiology and implications for management.

Ureteropelvic junction (UPJ) obstruction is a well-studied phenomenon in terms of its etiology, implications for renal function, and clinical management. The presence of concomitant ipsilateral calculus disease, however, introduces a confounding variable into the understanding of this entity. This article discusses the relationship between renal calculi and UPJ obstruction as it pertains to their pathophysiology and clinical management as combined entities.

Adult↗
PubMed1998

Differential expression of urinary inter-alpha-trypsin inhibitor trimers and dimers in normal compared to active calcium oxalate stone forming men.

PURPOSE: We determine if the immunoreactive profile of urinary inter-alpha-trypsin inhibitor can be used to distinguish between normal individuals and individuals with calcium oxalate stone disease. MATERIALS AND METHODS: Urinary proteins were dialyzed against water (15 kDa. molecular weight cutoff), lyophilized and resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (6% acrylamide, reducing conditions) followed by Western blot. Inter-alpha-trypsin immunoreactive proteins were detected by enhanced chemiluminescence. Stone formation was confirmed to be active radiologically or passed as stone or gravel within 12 months of the sample. Stone composition was confirmed crystallographically. Normal individuals had no personal or familial history of urolithiasis and matched stone forming patients regarding race (white) and age (23 to 71 years old). Urine from a total of 101 individuals was analyzed. RESULTS: The intact inter-alpha-trypsin trimer (approximately 220 to 240 kDa.) and heavy chain (HC) 2-bikunin/HC1-bikunin dimers (approximately 115 to 130 kDa.) were detected more often in stone forming men (23 of 26 [89%] and 26 of 26 [100%], respectively) than in normal individuals (6 of 26 [23%] and 5 of 26 [19%], respectively, p < 0.0001). In those normal individuals who expressed inter-alpha-trypsin trimer and HC-bikunins the relative intensities were 5.3+/-1.4% and 16.3+/-17.1% of the stone forming controls, respectively. The identity of high molecular weight-inter-alpha-trypsin immunoreactive bands was confirmed using antibodies against the individual subunits (HC1, HC2, HC3, bikunin). In contrast to men high molecular weight-inter-alpha-trypsin's were readily detected in normal and stone forming women with equal frequency (inter-alpha-trypsin-trimer p=0.1337, HC-bikunins p=0.2836): inter-alpha-trypsin-trimer 17 of 18 [94%] and 9 of 13 [77%]; HC-bikunins 17 of 18 [94%] and 10 of 13 [85%]). Inter-alpha-trypsin-trimer and HC-bikunins, respectively, were detected in 2 and 5 of 10 patients with chronic renal disease. Expression was not related to hematuria or proteinuria. CONCLUSIONS: Immunoreactive profiles of urinary proteins may be able to be developed into a useful diagnostic tool to identify active stone formation, although a separate panel may be required for men and women. It is possible that these differences may provide clues as to why the incidence of stone disease is higher in men than women.

Adult↗
PubMed1997

Role of finasteride in the treatment of recurrent hematuria secondary to benign prostatic hyperplasia.

OBJECTIVES: We evaluated the efficacy of finasteride for the treatment of gross hematuria secondary to benign prostatic hyperplasia in a prospective fashion. METHODS: Twelve patients with recurrent episodes of gross hematuria secondary to benign prostatic hyperplasia were treated with finasteride 5 mg/day. Before initiating treatment, we excluded other sources of hematuria using intravenous urography, cystoscopy, and urine culture. RESULTS: Bleeding subsided within 2 weeks of treatment in all 12 patients. Minimum follow-up was 6 months. Finasteride was well tolerated by all 12 patients. CONCLUSIONS: Finasteride appears to be effective in treating recurrent gross hematuria secondary to benign prostatic hyperplasia. This therapy should be considered an alternative to transurethral resection of the prostate or hormonal ablation in patients with recurrent hematuria and no significant obstructive uropathy or adenocarcinoma of the prostate.

Enzyme Inhibitors↗
PubMed1997

Ultrasound reflections fail to reflect the histopathology of the prostate.

High-resolution profiles of the reflections of a broad-band 4 MHz ultrasound pulse from radical prostatectomy and autopsy specimens in vitro have been captured and analyzed. An attempt was made to correlate the histopathology of each prostate reflection site with the profile of the pulse reflected from that site. Reflections from 125 sites on 22 prostate specimens were studied. Although the reflected pulse from each site displayed a distinctive profile, we could find no obvious correlation between the shape of that profile and the histologic findings at that site.

Autopsy↗
PubMed1997

High resolution two-dimensional electrophoretic analysis of urinary proteins of patients with prostatic cancer.

In an attempt to identify marker(s) for prostatic cancer, proteins in urines of normal and prostatectomized males and in men with cancerous prostate were analyzed. Only urines collected with protease inhibitors were examined. Two-dimensional (2-D) gel electrophoresis was used for high resolution separation of proteins and the electrophoretograms were either developed by double stain or the proteins were electrophoretically transferred onto nitrocellulose for immunological identification. The pool of each group exhibited similar relative positions of major protein spots. The study of normal and prostatectomized men identified two proteins denoted as A (36 kDa, pI 6-6.5) and B (23 kDa, pI 6.6), which were undetectable in the latter group. A visual comparison of the patterns of normals and patients with cancerous prostate revealed that both these proteins were undetectable in urines of men with malignant prostatic carcinoma (PCA) and benign prostatic hyperplasia (BPH) and hence may be useful in identifying prostatic carcinoma. Also, while protein C 43.5 kDA, pI 6-6.6) was discerned in normals its abundance, along with those of proteins D (40 kDa, pI 6-6.4) and E (26.5 kDa, pI 6-6.7), appeared to be higher in BPA than in PCA. Protein F (18-28 kDa, pI 4-5.5) was found in patients with BPH but was undetected in normals and men with PCA. Hence, it may become useful in distinguishing BPH from PCA. All the proteins, A to F, appear to be previously unidentified. Their further characterization is warranted.

Biomarkers, Tumor↗
PubMed1997

Adrenal metastases from renal cell carcinoma: role of ipsilateral adrenalectomy and definition of stage.

OBJECTIVES: We undertook this study to establish criteria for adrenalectomy in patients with renal cell carcinoma. METHODS: We retrospectively reviewed the records of 162 patients undergoing radical nephrectomy from 1979 to 1993 at University Hospitals of Cleveland. Simultaneous ipsilateral adrenalectomy was performed in 57 patients (35%). RESULTS: Three of these 57 patients (5.3%) had ipsilateral adrenal metastases. All 3 patients had large, left-sided, upper-pole tumors that extended through the renal capsule (Stage T3a). All 3 patients with adrenal metastases had progression to disseminated disease, with an average time to progression of 7.2 months, whereas only 13 (24%) of the 54 patients without adrenal metastases developed metastatic disease (none to adrenal), with an average time to progression of 27.6 months. No patient with organ-confined disease (Stage T1 or T2) or extracapsular disease in the midkidney or lower pole had adrenal metastases identified histologically. CONCLUSIONS: The prognosis is poor for renal cell carcinoma with ipsilateral adrenal involvement, even with complete removal. Because of this poor prognosis, we believe that adrenal involvement should constitute a separate stage category. We propose that patients with ipsilateral adrenal metastases via direct extension should be classified as having pathologic Stage pT3d. If the patient has an ipsilateral adrenal metastasis not via direct extension, contralateral adrenal metastasis, or bilateral adrenal metastases, the pathologic stage should be M1. Ipsilateral adrenalectomy should only be performed if a lesion is seen preoperatively on computed tomographic scan or if gross disease is seen at the time of nephrectomy although its removal may not benefit the patient.

Adrenal Gland Neoplasms↗
PubMed1997

Ethnic and geographic diversity of stone disease.

OBJECTIVES: To ascertain diversity or similarity in stone prevention and problems among different countries around the world. METHODS: Urolithiasis research groups from 10 countries completed a questionnaire. RESULTS: Cost of extracorporeal shock wave lithotripsy (ESWL) was considerably greater than that of drugs in four countries, and equivalent in remaining countries. Stone composition was similar among different countries. Certain urinary risk factors were associated with particular countries, probably from dietary indiscretions. ESWL was used in the majority of patients and open surgery in a minority of patients, except in one country. Medical diagnostic evaluation was used in the majority of patients except in one country. Drug treatment was nonselective, and provided to a minority of recurrent stone-formers. CONCLUSIONS: There is considerable similarity in stone presentations and problems throughout the world. The diversity is likely to be due to nutritional-environmental and socio-political-economic factors.

Cost-Benefit Analysis↗
PubMed1997

Cystine calculi. Diagnosis and management.

The genetics, pathophysiology, diagnosis, and treatment of cystinuria are discussed in this article. Newer chemotherapeutic and surgical options that are used to treat this disease process also are reviewed. The authors suggest a multimodal approach in the treatment of cystinuria and cystine calculi.

Cystine↗
PubMed1997

Use of prostate-specific antigen, Gleason score, and digital rectal examination in staging patients with newly diagnosed prostate cancer.

CT Scan, MR Imaging Scan, and Pedal Lymphangiography. Patients with a PSA greater than 25 ng/mL, a Gleason score greater than 6, and a positive DRE should undergo CT scan with FNA of lymph nodes at least 6 mm in size. Otherwise, CT scan, MR imaging scan, and pelvic lymphangiogram are not indicated. This should eliminate use of these staging studies in over 90% of patients with newly diagnosed adenocarcinoma of the prostate. Pelvic Lymph-Node Dissection. Pelvic lymph-node dissection can be safely eliminated in patients who meet the following predictive criteria: 1. PSA not more than 5 ng/mL or 2. Gleason score not more than 5 or 3. A combination of the following: PSA not more than 25 ng/mL, Gleason score not more than 7, and negative DRE. Following these criteria should eliminate the need for pelvic lymphadenectomy in 60% of patients with newly diagnosed prostate cancer.

Humans↗