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Biomedical subjects

M K Gelbard

Publications and source records attributed to M K Gelbard.

15 recordsLinked to original sources
PubMed1995

Relaxing incisions in the correction of penile deformity due to Peyronie's disease.

PURPOSE: The use of tunica albuginea relaxing incisions, a common component of several operative techniques for correction of penile deformity due to Peyronie's disease, is reviewed. MATERIALS AND METHODS: Of 93 operations performed for penile straightening 24 involved relaxing incisions with penile prosthesis implantation but no grafts and 69 involved autologous free grafts into relaxing incisions without use of an implant. RESULTS: Relaxing incisions were uniformly effective in correcting penile curvature when used in conjunction with a prosthesis. When autologous grafts were used without an implant, more than 80% of the patients with dorsal or ventral bending had a good result, compared to only 17% with lateral bending. CONCLUSIONS: Relaxing incisions are an effective technique for changing the shape of the erect penis by altering the configuration of the tunica albuginea at maximal extension.

Humans↗
PubMed1993

Collagenase versus placebo in the treatment of Peyronie's disease: a double-blind study.

We investigated 49 men with Peyronie's disease in a prospectively randomized placebo controlled double-blind study, comparing the effects on plaque size and penile deformity of intralesional purified clostridial collagenase and saline placebo. For the group as a whole, treatment out-performed placebo (p < 0.007). When patients were analyzed with respect to disease severity, those with lesser deformity responded more favorably to treatment. The absolute angular change in patients responding to treatment was small. No significant side effects were noted within a 3-month followup.

Collagenases↗
PubMed1991

Expanding contractures of the tunica albuginea due to Peyronie's disease with temporalis fascia free grafts.

We describe a procedure to expand contractures of the tunica albuginea by multiple full thickness relaxing incisions followed by inlay of tailored temporalis fascia free grafts. This technique is performed without resection of the tunica albuginea, although in the case of calcified plaques the calcifications themselves are removed, preserving the overlying tunica. Between September 1988 and February 1990, 12 patients have undergone this procedure, all of whom have greater than 3 months of followup and have experienced spontaneous erections within the first week postoperatively. Of the patients 11 resumed intercourse within 8 weeks of surgery and 1 required 12 weeks. No patient had sensory loss postoperatively and there has been no donor site morbidity. Correction of curvature was accomplished in all patients and there have been no recurrences within a maximal followup of 22 months. Within the limitations of such a small study we believe that there is evidence supporting this approach in potent patients with severe acquired penile curvature.

Fascia↗
PubMed1990

The natural history of Peyronie's disease.

The natural history of Peyronie's disease was evaluated in 97 men by means of a questionnaire. Disease duration ranged from 3 months to 8 years. Questions addressed pain, bending, ability for intercourse, over-all effect of the disease, psychological effects, treatments received and degree of disease progression. Approximately 40% of the patients found pain, bending, ability for intercourse and over-all effects to be unchanged during the course of the disease. Bending and ability for relations worsened in 40% of the patients during the same interval, while only 6% had worsening of pain. Of the patients 77% reported psychological effects due to Peyronie's disease, which improved in 28%, did not change in 36% and worsened in 36%. Over-all, 13% of the patients believed the disease to be one of gradual resolution, 47% believed there had been little or no change and 40% believed that the disease pattern was one of gradual progression. We found no statistically significant association between disease duration and spontaneous improvement in penile bending. A similar lack of statistical significance was found when improvement in a variety of categories was compared in patients who received no therapy versus those who received a variety of conventional medical therapies.

Attitude to Health↗
PubMed1988

Dystrophic penile calcification in Peyronie's disease.

Plain film radiography was performed in 66 consecutive patients with Peyronie's disease. Dystrophic calcification was noted in 22 patients (33 per cent). Patients with dystrophic calcification were younger (p less than 0.025) and had a more severe deformity (p less than 0.05) than those without calcification.

Adult↗
PubMed1986

Humoral immune responses in Peyronie's disease patients receiving clostridial collagenase therapy.

Human IgG and IgE antibody responses to clostridial collagenase (Nucleolysin) were monitored in 150 untreated healthy blood donors and 44 patients receiving intrapenile injections of collagenase for treatment of Peyronie's disease. Pre, 1 and/or 2 month post treatment sera were analyzed in radioimmunoassays for human IgG and IgE antibodies using solid phase purified Cl. histolyticum collagenase to extract antibodies from serum and 125I-Protein A or rabbit anti-human IgE to detect bound IgG and IgE, respectively. IgG and IgE antibody levels greater than 2.5 Units and 0.2 per cent Bmax, respectively, were considered positive if the binding was greater than 80 per cent inhibitable with soluble collagenase. IgG anti-collagenase was detected in 34 per cent of the 150 healthy controls and 58 per cent (24/41) of untreated Peyronie's disease patients. Intralesional injection of 3,000 to 12,650 Units of collagenase induced an increase of two- to 10-fold in the IgG levels at one to two months in 88 per cent of patients. Of the 186 individuals tested, only one (0.5 per cent) had detectable collagenase-specific IgE antibody in his serum as defined by positive threshold and antigen inhibition criteria.

Adult↗
PubMed1985

The use of collagenase in the treatment of Peyronie's disease.

Purified clostridial collagenase was administered intralesionally in 31 men with Peyronie's disease. Within 4 weeks of treatment 20 patients showed an objective improvement. Pain was eliminated in 13 of 14 patients with this complaint at presentation within the same 4-week period. The ability to have intercourse was restored in 3 of 4 patients with this problem. Except for a small corporeal rupture at the site of injection in 1 patient, no significant untoward effects were noted. During the mean 9.8-month followup 1 recurrence of bending was noted.

Adult↗
PubMed1982

Collagenase for Peyronie's disease experimental studies.

This pilot study was designed to test the feasibility of using purified clostridial collagenase in the clinical management of Peyronie's disease. The basic properties of this agent are discussed. We studied its effect on Peyronie's plaque tissue by a quantitative in vitro assay utilising the liberation of free alpha-amino groups as an index of enzymatic collagenolysis. Tissue from three patients with Peyronie's disease was used. Tunica albuginea from a second group of three normal patients was studied in the same manner, and no selectivity for the collagen of Peyronie's plaques was identified. Utilising human pericardium as a uniform collagenous substrate, a simple dose-effect relationship was established, and the distribution characteristics of injected collagenase observed. Its effects on blood vessels and nerves in vivo was determined as well as the effects of collagenase on the histology of normal and diseased human tissue in vitro. A tentative dose for use in Peyronie's disease was established, which is discussed in light of existing toxicological data. The study was designed to test the feasibility of purified collagenase in the clinical management of Peyronie's disease. Data included detail plaque digestion and dose-effect relationships in vitro, as well as the histological effects on plaques, blood vessels, and nerves in vivo and in vitro. It is concluded that collagenase may warrant further clinical testing in the treatment of Peyronie's disease.

Animals↗