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Biomedical subjects

M K Terris

Publications and source records attributed to M K Terris.

At least 37 records · Page 2Linked to original sources
PubMed2000

Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy.

PURPOSE: We determined the incidence and predisposing factors of bacteremia and bacteriuria after prostate biopsy with specific emphasis on the value of a pre-biopsy enema. MATERIALS AND METHODS: We randomized 50 men undergoing ultrasound and biopsy to rule out prostate cancer to receive a preoperative (25) or no (25) enema. Preoperatively urine was obtained for culture, and questionnaires regarding urological history and voiding symptoms were completed. The initial prostate biopsy, biopsy needle, and postoperative urine and blood specimens were cultured. The following day a symptom questionnaire was completed. RESULTS: Bacterial growth in post-procedure cultures did not correlate with the number of biopsies, prostate specific antigen, obstructive voiding symptoms, prostate volume, cancer or post-biopsy hematuria. Bacteriuria was noted in 44% of the cases and bacteremia was present in 16% of the patients, of whom 87.5% did not receive an enema (p = 0.0003). Only 1 patient had chills and fever greater than 37.5C, requiring additional antibiotics. On the followup questionnaire 12% of patients described dysuria, including 84% with bacteriuria after biopsy. CONCLUSIONS: Bacteremia and bacteriuria after multiple biopsies are common but usually asymptomatic. Bacteria is apparently introduced into the urine and/or blood from the rectum via the biopsy needle, which may be minimized by a pre-biopsy enema. Dysuria or a history of urinary tract infection did not predict problems after biopsy.

Aged↗
PubMed1999

Comparison of the breaking strength of polyglactin mesh in urine, serum, and cell culture media.

OBJECTIVES: This study was designed to determine the durability of polyglactin woven mesh in various in vitro environments, including urine, since polyglactin 901 mesh has been considered for implementation in urinary tract reconstruction. METHODS: Segments of 1 x 1-cm sterile woven and knitted polyglactin 910 mesh with and without collagen coating were exposed to the following conditions: dry (at room temperature and at 37 degrees C, humidified air), in porcine and human serum and urine, in porcine urine over a range of pH levels, in infected urine, in cell culture media (MCDB 105 with 5% fetal bovine serum), and in cell culture media with porcine bladder fibroblasts. The mesh breaking strength was measured at 0, 12, 21, 28, and 36 days. RESULTS: The mean breaking strength for dry, room temperature mesh segments measured 350 g for all time intervals. At day 21, the breaking strength for all mesh types in human and porcine serum, cell culture media, and cell culture media with bladder fibroblasts was less than 10% of the control, but the human and porcine urine maintained 12% to 24% of the control breaking strength (this difference did not reach statistical significance). There was no significant difference in the breaking strength in human and porcine urine or human and porcine serum. By day 38, the breaking strength for all mesh types in all solutions was less than 5% of the control breaking strength. The presence of fibroblasts increased the rate of degradation of the mesh compared with the urine, serum, and cell culture media alone. There was a significant prolongation of degradation with decreasing pH, as well as with infected urine. This prolongation was additive; in fact, all mesh types in low pH (5.0), infected urine showed minimal degradation at 38 days. CONCLUSIONS: In acidic infected urine, the durability of polyglactin 910 mesh is significantly prolonged compared with the other conditions tested. Therefore, when used in urinary tract reconstruction, as in other organ systems, the integrity of the polyglactin mesh should diminish rapidly after 3 weeks as long as the urine is kept sterile and a neutral to alkaline pH is maintained.

Animals↗
PubMed1999

Sensitivity and specificity of sextant biopsies in the detection of prostate cancer: preliminary report.

OBJECTIVES: To determine the true-negative and false-negative rates of sextant prostate biopsies, the most common method of prostate cancer diagnosis. METHODS: Forty-three men scheduled for prostatectomy as part of a surgical procedure for bladder pathologic findings agreed to participate in this study. All patients had normal digital rectal examination findings. Immediately before prostatectomy all patients underwent sextant biopsies. The location, amount, and Gleason grade of any cancer identified on the biopsies were recorded. After surgery, the prostate was serially sectioned. The location, grade, and volume of any prostatic adenocarcinoma identified was recorded and compared with the results of the biopsy specimens. RESULTS: There were 33 patients without prostate cancer in either the biopsies or the prostatectomy specimen. No patients had cancer on the biopsies and no cancer in the prostatectomy specimen. In 6 patients, cancer was found in both the biopsies and the prostatectomy specimens; these cancers were 0.9, 2.1, 2.8, 3. 1, 4.2, and 6.5 cc in volume. In the remaining 4 patients, there was no cancer on the biopsies but the prostatectomy specimen revealed cancers of 0.05, 0.1, 0.3, and 2.5 cc. The overall sensitivity for sextant biopsies was 60.0%, with a specificity of 100%. When only cancers greater than 2 cc or cancers in the peripheral zone were considered, the sensitivity rose to 83.3% and 71.4%, respectively, with a minimal decrease in specificity (97.3% and 97.2%, respectively). In contrast, when transition zone cancers were evaluated, the sensitivity fell to 33.3%. CONCLUSIONS: Sextant biopsies are fairly sensitive for the detection of tumors greater than 2 cc and those in the peripheral zone; however, repeat biopsies should be strongly considered in patients with a high clinical suspicion for prostate cancer and negative initial sextant biopsies.

Adenocarcinoma↗
PubMed1999

Limitations of transperineal ultrasound-guided prostate biopsies.

OBJECTIVES: Screening and diagnosing prostate cancer in men who have undergone abdominoperineal resection (APR) poses a diagnostic challenge. Transperineal ultrasound is an effective imaging technique, but the sensitivity of transperineal needle biopsy under ultrasound guidance has not been evaluated. We compared the results of transrectal ultrasound-guided (TRUS) biopsies and transperineal ultrasound-guided (TPUS) biopsies obtained from patients with known prostate cancer, to evaluate the accuracy of TPUS prostate biopsies. METHODS: Twenty patients with prostate cancer diagnosed by TRUS-guided biopsies were studied. Immediately before radical prostatectomy, TPUS was performed in the lithotomy position and six TPUS-guided biopsies were obtained. Routine sextant TRUS-guided biopsies were then obtained. Finally, radical retropubic prostatectomy was performed and the results of both biopsy sets were compared with the pathologic features of the surgical specimen. RESULTS: All 20 prostates contained adenocarcinoma. The prostate was well visualized with TPUS and TRUS in all cases. TPUS-guided biopsies detected cancer in only 2 of the 20 specimens, yielding a sensitivity of 10%. On the same specimens, TRUS-guided biopsies were positive in 13 of 20 cases, a sensitivity of 65%. Cancers detected by TPUS-guided biopsies tended to have a higher volume, higher Gleason grade, and higher prostate-specific antigen level than those not detected by TPUS-guided biopsies. CONCLUSIONS: TPUS-guided sextant biopsies are less accurate than TRUS-guided sextant biopsies in detecting prostate cancer, even in the hands of experienced ultrasonographers. The limitations of TPUS-guided needle biopsies emphasize the importance of screening for prostate cancer before APR.

Adenocarcinoma↗
PubMed1999

Transrectal ultrasound appearance of squamous cell carcinoma involving the prostate.

PURPOSE: This report describes the transrectal ultrasound appearance of squamous cell carcinoma of the prostate. CASE REPORTS: One case of squamous cell carcinoma involving the prostate by extension from a primary urethral carcinoma and a second case of radiation-induced primary prostatic squamous cell carcinoma are presented and the ultrasound findings discussed. CONCLUSIONS: In these 2 cases, squamous cell carcinomas involving the prostate exhibited similar transrectal ultrasound appearances. Both lesions demonstrated an irregular, anterior, relatively hyperechoic appearance.

Aged↗
PubMed1999

Clinical and radiological findings in patients with gas forming renal abscess treated conservatively.

PURPOSE: Emphysematous pyelonephritis in diabetics is considered a potentially lethal infection. Mortality rates of patients treated conservatively approaches 80% in some series. These patients often present with signs of sepsis or septic shock. In contrast, gas forming renal abscess is rare, with patients presenting entirely differently from those with emphysematous pyelonephritis. To our knowledge this process has been previously described only in isolated case reports. We describe a series of 5 patients with this distinct process. MATERIALS AND METHODS: We reviewed the clinical and radiological features of 5 patients with gas forming renal abscesses. RESULTS: Each patient presented with diabetes mellitus with initial blood glucose ranging from 313 to 552 mg./dl., fever (average 101F), flank or abdominal pain and pyuria. No patient had evidence of septic shock at hospitalization. Escherichia coli was the documented organism in each case. Mild renal insufficiency was noted in most patients based on serum creatinine. Radiological evaluation revealed gas filled pockets within the renal parenchyma, which were most effectively shown by computerized tomography (CT) of the abdomen. There was no radiological evidence of pus. Percutaneous drainage of an abscess in 1 case did not produce any purulent material or alter the clinical course. Each patient responded to correction of the underlying metabolic abnormalities with intravenous antibiotics (average 23 days) followed by prolonged oral antibiotic therapy (average 9 weeks). In contrast to the management of emphysematous pyelonephritis, surgical or percutaneous drainage was not necessary. Serial CT revealed complete resolution of gas in the parenchyma within 6 months in patients with long-term followup. Of note, gas was persistent on CT months after infection had clinically resolved. CONCLUSIONS: We describe a unique entity within the spectrum of pyelonephritis. The clinical appearance of gas forming abscesses within the renal parenchyma without liquefaction in diabetic patients was remarkably benign compared to the radiographic appearance of the disease process. Conservative management with intravenous and oral antibiotics was successful in each patient, avoiding the need for invasive intervention.

Abdominal Abscess↗
PubMed1998

Transrectal ultrasound appearance of radiation-induced prostatic sarcoma.

BACKGROUND: Delayed development of prostatic sarcoma is a rare complication of prostatic pelvic irradiation. The transrectal ultrasound appearance of this lesion has not been previously described. METHODS: Three cases of radiation-induced prostatic sarcoma are presented, with emphasis on the transrectal ultrasound findings. RESULTS: An irregular, hypoechoic prostatic mass with an anechoic area consistent with the echogenicity of muscle and/or necrosis was found in all 3 patients. This appearance is distinctly dissimilar from prostatic adenocarcinoma. CONCLUSIONS: The sonographic finding of an irregular, hypoechoic prostatic mass with an anechoic area should raise suspicion for prostatic sarcoma in patients with a history of pelvic irradiation who develop an abnormal prostate on rectal examination and/or worsening voiding symptoms despite a normal serum prostate-specific antigen level.

Adult↗
PubMed1998

Transrectal ultrasound appearance of hematolymphoid malignancies involving the prostate.

OBJECTIVES: Although the clinical presentation and physical examination findings in patients with lymphoma or leukemia involving the prostate have been described previously, the transrectal ultrasound appearance of hematolymphoid malignancies involving the prostate has not been previously described. METHODS: Nine patients with prostate cancer diagnosed by transrectal ultrasound-guided prostate biopsies were found to have hematolymphoid malignancies involving the prostate at the time of subsequent radical prostatectomy and pelvic lymph node dissection. The ultrasound images and prostate needle biopsy results are presented. RESULTS: Prospective analysis of transrectal ultrasound images revealed no abnormality other than hypoechogenicity typical of prostate cancer in 7 of the 9 patients (77.8%). In 2 patients, the ultrasound images were free of any abnormalities. In 2 of the 9 patients (22.2%), the prostate needle biopsies demonstrated suspicious lymphocytic infiltrate in addition to prostate cancer. CONCLUSIONS: Transrectal ultrasound does not detect hematolymphoid malignancies involving the prostate. Ultrasound-guided biopsies of the prostate have a very low rate of detecting these malignancies.

Adenocarcinoma↗
PubMed1998

Comparison of prostate size in university and Veterans Affairs Health Care System patients with negative prostate biopsies.

OBJECTIVES: Many important prostate studies take place at Veterans Affairs hospitals. We have examined whether the patient population at these institutions is comparable to the population presenting for prostate evaluation at university hospitals. METHODS: We included all patients presenting for transrectal ultrasound (TRUS) and biopsy in whom systematic biopsies failed to reveal prostate cancer at both Stanford University Medical Center (90 patients) and the Palo Alto Veterans Affairs Health Care System (103 patients) from August 1, 1995 to July 31, 1996. Identical techniques and equipment for TRUS examination and prostate size determination were used at both institutions. RESULTS: There was no significant difference in the age or prostate-specific antigen (PSA) levels of the patients at the two institutions. The mean prostatic volume of the Stanford University patients was 71 cm3 (median 63 cm3), whereas the mean prostatic volume of patients at the Palo Alto Veterans Affairs hospital was 52 cm3 (median 43 cm3), a highly statistically significant difference (P = 0.0009). CONCLUSIONS: The smaller size of the prostate glands in Veterans Affairs patients may be the result of differences in referral base, socioeconomic factors, or environmental factors. These data may have significance for trials conducted only on the prostates of men who are seen at Veterans Affairs hospitals.

Adult↗
PubMed1998

Correlation of transrectal ultrasound measurements of prostate and transition zone size with symptom score, bother score, urinary flow rate, and post-void residual volume.

OBJECTIVES: To assess the correlation of total prostatic size and prostate transition zone dimensions with various measurements of the severity of bladder outlet obstruction secondary to benign prostatic hyperplasia. METHODS: Prostate-specific antigen, creatinine, American Urological Association symptom score, bother score, urinary history, uroflowmetry, and post-void residual urine volume determination was followed by measurement of the prostate gland and transition zone on transrectal ultrasound images in 136 men undergoing systematic prostate biopsies. Patients were divided into five groups based on past urinary tract treatment history and the presence of prostate cancer on the biopsies. The total prostate and transition zone dimensions, as well as calculated prostate and transition zone volumes, were compared by Pearson correlation with both the subjective and objective voiding parameters in each patient group. RESULTS: The transition zone dimensions correlated positively with American Urological Association symptom score, bother score, and post-void residual urine volume and correlated negatively with maximum and mean flow rates, particularly in patients with no history of prostate surgery, alpha-blocker administration, urinary infections, irritative voiding symptoms, or prostate cancer. CONCLUSIONS: Transrectal ultrasound measurements of transition zone dimensions correlate better than total prostatic dimensions or calculated prostatic or transition zone volumes with the severity of benign prostatic hyperplasia. Of these, the transverse transition zone dimension demonstrated the best correlation; however, this correlation is probably not adequate for clinical utility.

Aged↗
PubMed1998

Comparison of ultrasound imaging in patients undergoing transperineal and transrectal prostate ultrasound.

OBJECTIVES: Prostatic evaluation in men who have undergone prior abdominoperineal resection pose an unusual challenge for the urologist. Neither digital rectal examination nor transrectal ultrasound (TRUS) can be performed. Transperineal ultrasound (TPUS) has been suggested as an alternative means of imaging. This imaging modality was compared directly with the standard TRUS method. METHODS: TPUS was performed with a 4-MHz abdominal probe or biplane multiple frequency probe at a frequency of 5 to 7 MHz followed by TRUS at 7 MHz in 50 consecutive men referred for prostate ultrasound and biopsy who had not undergone prior abdominoperineal resection. Dimensions of the prostate and ultrasound findings such as hypoechoic, anechoic, or hyperechoic areas were noted for each sonographic approach. Volume calculation was performed by the prolate spheroid method. RESULTS: There was good TPUS visualization of the prostate in the transverse plane in 48 (96%) of 50 patients and in the sagittal plane in 45 (90%) of 50 patients. Prostate volume calculation by TPUS correlated well with the volume calculated by TRUS (r=0.876). Twenty-nine patients (58%) were found to have suspicious hypoechoic lesions by TRUS; none were seen by TPUS. Prostatic calcifications were present in 12 patients and were visualized by both TPUS and TRUS in all 12 patients. Six prostate glands demonstrated cystic lesions on TRUS imaging; three of these cystic lesions were also seen with TPUS imaging. CONCLUSIONS: TPUS allows visualization of the prostate with volume determination that is comparable to the volume determination by TRUS. Some intraprostatic findings such as calcifications and cysts can be identified; however, suspicious hypoechoic lesions were not identified by TPUS imaging of the prostate.

Aged↗
PubMed1998

Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature.

PURPOSE: Transrectal ultrasound guided needle biopsy of the prostate is routinely performed to diagnose and stage prostate cancer. We prospectively evaluated the true incidence of complications and identified risk factors of needle biopsy. MATERIALS AND METHODS: We prospectively studied 128 patients who underwent transrectal ultrasound guided needle biopsy. A pre-biopsy questionnaire provided demographic information. Immediate complications were recorded by the surgical team at the procedure. Information on delayed complications was obtained by telephone interview. Univariate and multivariate analyses were performed. RESULTS: There was 1 major and 135 minor complications in 77 patients with at least 1 complication in 63.6%. Most patients tolerated the procedure with minimal discomfort regardless of the number and location of biopsies but younger patients had significantly more discomfort than older men (R = -0.26, p = 0.005). The most common complication was persistent hematuria in 47.1% of cases. None of the hemorrhagic complications was related to previous aspirin or nonsteroidal anti-inflammatory drug use, or the total number of biopsies performed. Infectious complications were rare with only a 1.7% incidence of fever. This rate was associated with the choice of antibiotic combination used (R = 0.25, p = 0.006). CONCLUSIONS: Transrectal ultrasound guided needle biopsy is safe for diagnosing prostate cancer with few major but frequent minor complications. Patients are likely to have persistent hematuria for up to 3 to 7 days after the procedure. Recent use of aspirin or nonsteroidal anti-inflammatory drugs is not an absolute contraindication for this procedure. Additional analgesics are not required in patients who undergo anterior or multiple biopsies but they may be useful in younger patients.

Aged↗
PubMed1998

Renal masses presenting 25 and 50 years following blunt renal trauma.

The long-term consequences of blunt renal trauma are not well described. We report on 2 patients with a history of blunt renal trauma who presented with radiographically detected renal masses suspicious for renal tumor. Both patients suffered blows to the kidney during boxing matches followed by flank pain and hematuria. The injuries occurred 25 and 50 years prior to the detection of renal masses. Subsequent nephrectomy and histopathological evaluation revealed benign dystrophic renal tissue. These presentations represent probable long-term sequelae of blunt renal trauma.

Aged↗
PubMed1997

Human papillomavirus detection by polymerase chain reaction in benign and malignant prostate tissue is dependent on the primer set utilized.

OBJECTIVES: Prior investigations evaluating the presence of human papillomavirus (HPV) in prostatic tissue by polymerase chain reaction (PCR) technology have yielded detection rates of 0% to 100%. Contamination by viral DNA from prostatic urethral colonization or less than optimal laboratory conditions have been suggested to explain this discrepancy. In addition, the various investigations have differed in the specific oligonucleotide primers utilized for amplification and, therefore, have searched for different segments of the viral genome. The objective of this study is to address these differences. METHODS: Forty-one archival radical prostatectomy specimens were evaluated, identifying areas of normal and abnormal histology. Meticulous technique was used during tissue acquisition, histologic confirmation, DNA isolation, PCR amplification, polyacrylamide gel electrophoresis, and staining. Primers for a 126- and 99-base pair (bp) fragment of the E6 portion of HPV 16 as well as a consensus primer for the L1 portion of the papillomavirus genome were utilized. RESULTS: Of the normal prostatic tissues, 13.5% (5/37) contained the 126-bp E6 viral DNA as did 33.3% (7/21) of benign prostatic hyperplasia (BPH) samples, 25% (5/20) of dysplasia, 18.2% (2/11) of Gleason grades 1 and 2 adenocarcinoma, 25.9% (7/27) of Gleason grade 3 adenocarcinoma, and 6.7% (1/15) of Gleason grade 4 adenocarcinoma. Sections from the urethras of the prostatectomy specimens contained viral DNA in 31.7% (13/41). Viral detection was variable among different specimens in the same patient. With amplification for the 99-bp fragment of HPV 16, 1 of 37 normal (2.7%), 2 of 21 BPH (9.5%), 1 of 20 dysplasia (5.0%), and 2 of 53 cancer (3.8%) specimens revealed HPV DNA. In none of the specimens was DNA amplified using primers for a 450-bp fragment of the L1 portion of HPV. CONCLUSIONS: Previously published discrepancies in HPV detection may be solely due to the differences in primer sets utilized.

Adult↗
PubMed1997

Transrectal ultrasound appearance of prostatic granulomas secondary to bacillus Calmette-Guerin instillation.

PURPOSE: To our knowledge the transrectal ultrasound appearance of prostatic granulomas occurring after intravesical bacillus Calmette-Guerin (BCG) therapy has not been thoroughly described. MATERIALS AND METHODS: A total of 13 men with a history of transitional cell carcinoma of the bladder treated with intravesical BCG underwent transrectal ultrasound followed by prostate biopsy and/or cystoprostatectomy. RESULTS: Of the 13 patients studied 9 (69.2%) had intensely hypoechoic lesions anteriorly in the transition zone of the prostate on ultrasound images. The lesions were histologically proved to be necrotizing granulomas. CONCLUSIONS: Prostatic granulomas secondary to BCG instillation appear as distinct, intensely hypoechoic anterior lesions within the transition zone of the prostate. Prostatic adenocarcinoma arising in the transition zone is usually not visible and would not be easily confused with granulomas. However, since transitional cell carcinoma involving the prostate can appear hypoechoic in the transition zone, transrectal or transurethral tissue sampling may be indicated.

Administration, Intravesical↗