Biomedical subjects

M K Terris

Publications and source records attributed to M K Terris.

At least 55 records · Page 3Linked to original sources

PubMed1997

Transrectal ultrasound guided drainage of prostatic cysts.

PURPOSE: A technique for transrectal ultrasound guided drainage of prostatic cysts and large cystic utricles is described using simple adaptation of equipment readily available in the transrectal ultrasound suite. MATERIALS AND METHODS: Using the puncture trajectory display generated by the ultrasound unit, the biopsy needle is manually advanced through the needle guide of the transrectal ultrasound probe. Once the tip of the needle reaches the lumen of the cystic lesion, the central trocar of the needle is removed from the outer cannula and intravenous line tubing is inserted into the opening in the trocar. The syringe is attached to the opposite end of the extension tubing, allowing for cyst aspiration. RESULTS: This technique was performed successfully in 11 patients with symptomatic cysts within the prostate, including 7 with intraprostatic cysts and 4 with cystic utricles. The fluid collection recurred in 1 patient with a cystic utricle, causing epididymal pain and orchialgia that resolved with repeat drainage. CONCLUSIONS: This technique allows for easy, successful drainage of symptomatic prostatic cysts in an outpatient setting without specialized equipment or anesthesia.

Cysts↗

PubMed1997

Mucinous adenocarcinoma of the renal pelvis in natives of India.

A case of mucinous adenocarcinoma of the renal pelvis and ureter presenting as chronic flank pain, calculus, and hydronephrosis in an immigrant from India is presented. A literature review reveals a high frequency of reporting this otherwise rare tumor in India and suggests an inflammatory, environmental, or dietary etiology.

Adenocarcinoma, Mucinous↗

PubMed1997

An unusual complication following uroflowmetry: water intoxication resulting in hyponatremia and seizure.

Uroflowmetry is considered a simple and noninvasive test in the evaluation of urinary symptoms. It requires patients to consume fluid orally for a full bladder prior to undertaking the test. Guidelines regarding the amount and rate of oral fluid intake have not been accurately defined. We report on a patient who suffered a serious complication of water intoxication with hyponatremia and seizure due to excessive water consumption and absorption during uroflowmetry. We discuss the underlying factors concerning this complication and recommend a more conservative approach to attain a full bladder in a certain subgroup of patients at risk of developing such a complication.

Adult↗

PubMed1997

Comparison of mid-lobe versus lateral systematic sextant biopsies in the detection of prostate cancer.

OBJECTIVE: Systematic sextant biopsies are a powerful tool in the diagnosis of prostate cancer. Interpretation of the histopathologic results of these biopsies plays a central role in treatment decisions. This biopsy approach was originally described as sampling the prostate in the mid-lobe, parasagittal plane at the apex, mid-gland, and base, bilaterally. Morphometric analysis of prostate specimens has revealed that most clinically significant cancers are mainly located in the posterolateral aspect of the gland, not the mid-lobe. We sought to determine if cancer detection could be improved by obtaining more laterally placed biopsies. MATERIALS AND METHODS: Forty-one patients underwent transrectal ultrasound with mid-lobe sextant as well as lateral sextant biopsies. Biopsy specimens were evaluated for Gleason grade and length of cancer present in each core. The mid-lobe and lateral biopsy results were then compared. RESULTS: Thirteen of 41 patients (31.7%) were found to have no cancer on either biopsy set. Cancer was detected by both the mid-lobe and the lateral biopsies in 19 patients (46.3%). In 6 patients (14.6%), only the lateral biopsies revealed cancer, and in 3 patients (7.3%), only the mid-lobe biopsies revealed cancer. CONCLUSIONS: Laterally-placed systematic sextant biopsies may yield an improved diagnosis rate in patients with palpable nodularity in the lateral aspect of the prostate, patients without any palpable abnormalities but with elevated PSA levels, and in those patients undergoing repeat biopsies.

Adenocarcinoma↗

PubMed1997

Routine transition zone and seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided prostate biopsies are not indicated.

PURPOSE: Transrectal ultrasound guided biopsies of the transition zone and seminal vesicles have been useful in select patients. More widespread use of these additional biopsies has been proposed. The efficacy of routine transition zone and seminal vesicle biopsies was examined. MATERIALS AND METHODS: From January 1988 to October 1994, 736 transrectal ultrasound guided systematic sextant biopsies were performed. From October 1994 to July 1995, 161 consecutive patients underwent transrectal ultrasound with systematic sextant, transition zone and seminal vesicle biopsies. RESULTS: Of the 736 patients undergoing only sextant biopsies 309 (42.0%) had cancer and 24 (3.3%) required repeat biopsy, compared to 55 (34.2%) and 4 (2.5%) of 161 undergoing combined sextant, transition zone and seminal vesicle biopsies. Prostate cancer was found only in the systematic sextant biopsies in 43 of the former 55 patients (78.2%), and in the transition zone and systematic sextant biopsies in 11 (20.0%). One patient (1.8% of patients with cancer or 0.6% of all 161 patients) had cancer in only the anterior biopsies and 6 (10.9 and 3.7%, respectively) had cancer involving the seminal vesicles. CONCLUSIONS: Routine transition zone and seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided systematic sextant biopsies are not warranted.

Aged↗

PubMed1997

Hematolymphoid malignancies diagnosed at the time of radical prostatectomy.

PURPOSE: The clinical impact of hematolymphoid malignancies discovered during radical prostatectomy has not been previously defined to our knowledge. MATERIALS AND METHODS: From October 1988 to September 1995, 1,092 patients underwent radical retropubic prostatectomy. RESULTS: Of 1,092 radical prostatectomy specimens, 13 (1.2%) were found to have hematologic malignancies involving the prostate and/or lymph nodes sampled during concomitant pelvic lymph node dissection. The malignancies detected included Hodgkin's disease (3) and hairy cell leukemia (1), which required further therapy. However, 9 of the 13 patients (62%) demonstrated either chronic lymphocytic leukemia (3) or low grade, small lymphocytic lymphoma (6), which requires symptomatic treatment only. The transrectal ultrasound guided prostate biopsies revealed suspicious lymphocytic infiltrate in addition to prostatic adenocarcinoma in 2 of the 13 patients (15%). CONCLUSIONS: The majority of hematologic malignancies discovered at radical prostatectomy do not require further treatment and should not delay treatment of prostatic adenocarcinoma.

Adenocarcinoma↗

PubMed1996

Dosimetry studies utilizing the urolase right-angle firing neodymium:YAG laser fiber in the human prostate.

BACKGROUND AND OBJECTIVE: Until recently, little or no objective data have been available to support either the choice of power setting or the timing of laser applications to achieve optimal tissue ablation in the human prostate. The objective of this study was to define quantitative dosimetry curves for the Urolase right angle laser fiber in human prostates. STUDY DESIGN MATERIALS AND METHODS: Transurethral Neodymium:YAG laser application was performed with the Urolase right-angle laser fiber in adult human prostates prior to planned radical surgery. Depth and volume of prostatic tissue coagulation for single, continuous laser applications were measured at variable power settings from 20 to 60 watts while holding total energy delivery constant. Then, holding the power setting constant at 40 watts, the extent of tissue coagulation was measured for variable treatment times from 60 to 120 seconds. RESULTS: Peak tissue coagulation was observed at 40 watts up to a maximum of 14 mm tissue penetration and 4.23 cc volume coagulated following a single spot laser application. The mean depth of tissue coagulation at 40 watts power setting was 13.5 mm, with a mean volume of tissue coagulation of 3.68 cc. The mean depth of tissue penetration at 40 watts was more than 25% greater than that observed at 60 watts, and the mean volume of tissue coagulation was 190% greater than that observed at 60 watts. As treatment time was increased from 60 to 90 seconds, extent of tissue coagulation increased significantly. However, beyond 90 seconds continuous laser application at 40 watts, a plateau in tissue effects was observed, with minimal increase in tissue coagulation between 90 and 120 seconds. Histologic examination of prostates removed acutely showed heat-induced damage to both stromal and glandular epithelial elements in laser-treated areas. At 1 year, the prostatic urethra was lined with a normal transitional epithelium, and mild periurethral fibrosis with focal squamous metaplasia was seen. CONCLUSION: Using the Urolase right-angle laser fiber, this study suggests that 40 watts power setting and 90 seconds continuous application time with a Neodymium:YAG laser source represent optimal treatment parameters to maximize prostatic tissue coagulation.

Adult↗

PubMed1995

Prediction of prostate cancer volume using prostate-specific antigen levels, transrectal ultrasound, and systematic sextant biopsies.

OBJECTIVES: Prostate-specific antigen (PSA) levels, transrectal ultrasound, and systematic sextant biopsies have each shown limited ability to predict prostate cancer volume. In combination, these studies may allow more accurate estimation of volume and prognosis. METHODS: One hundred twenty-four patients were evaluated prior to radical prostatectomy. Interactive stepwise multiple regression and separate logistic regression analysis were performed for prediction of prostate cancer volume and volume range. RESULTS: The cancer volumes calculated correlated with the volumes in the radical prostatectomy specimens with R2 of 0.76. Cancers were predicted to be in the volume range associated with poor prognosis (more than 12 cc) or clinically insignificant cancer (less than 1.0 cc) with bias corrected error rates of 5.3% and 10%, respectively. CONCLUSIONS: The formula for prediction of cancer volume correlates well with actual cancer volume in 92 patients but is not adequate to predict volume for an individual patient. The formulas for prediction of volume range show promising predictive ability and may be useful if the extent of disease is unclear.

Aged↗

PubMed1995

Indications for ultrasound guided transition zone biopsies in the detection of prostate cancer.

Transrectal prostate ultrasound and systematic sextant biopsies have improved peripheral zone cancer diagnosis but they may miss many cancers arising in the transition zone. Biopsies directed into the transition zone have been used to detect residual prostate cancer in patients diagnosed by transurethral resection and they have been suggested as potentially useful additions to systematic sextant biopsies. To define the indications for transition zone biopsies 187 men underwent evaluation including systematic sextant biopsies and transition zone biopsies. These patients were classified into 4 categories based on clinical presentation. Category 1 included 26 men with palpable nodularity and an elevated prostate specific antigen (PSA), of whom 16 (61.5%) had positive biopsies but none was positive only in the transition zone biopsies. Category 2 consisted of 49 men with sonographic abnormalities in the transition zone, of whom 15 (30.6%) had positive biopsies, including 2 (13.3%) with only positive transition zone biopsies. Category 3 consisted of 65 men with normal rectal examination and elevated PSA level, of whom 24 (36.9%) had biopsies positive for cancer, including 8 (33.3%) with only positive transition zone biopsies. Category 4 consisted of 47 men with a clinical presentation highly suspicious of prostatic malignancy but no cancer on prior systematic sextant biopsies, of whom 17 (37.7%) had positive biopsies, including 9 (53.0%) with only positive transition zone biopsies. We conclude that transition zone biopsies are useful in patients with a high suspicion of prostate cancer and negative prior systematic sextant biopsies. Cancer can also be demonstrated in many men with a normal digital rectal examination and an elevated PSA level. Patients with transition zone abnormalities on ultrasound images or palpable nodularity do not have substantially increased cancer detection with the addition of transition zone biopsies.

Aged↗

PubMed1994

Utilization of polyclonal serum prostate specific antigen levels in screening for prostate cancer: a comparison with corresponding monoclonal values.

OBJECTIVES: Prostate specific antigen (PSA) measurement has become increasingly popular as a screening test for prostatic adenocarcinoma. Although this is a sensitive, organ-specific assay, use as a screening tool is hampered by the lack of a clearly defined normal range in older men, frequent elevation of PSA levels by benign processes, and the availability of two different assays, one polyclonal and the other monoclonal, which produce very different values. This study was designed to evaluate the distribution of PSA levels by the Yang and corresponding Hybritech values in patients from the general population. SUBJECTS AND METHODS: A total of 478 volunteers over 40 years of age underwent serum PSA determination by the Yang polyclonal radioimmunoassay and digital rectal examination. The PSA levels were stratified and the patient distribution analysed. RESULTS: In 69% of patients, PSA levels were < or = 2.5 ng/ml (proposed normal range for the Yang polyclonal assay). In 89% of patients, PSA levels were < or = 7.3 ng/ml by the polyclonal assay which corresponds approximately to the proposed normal range of 0-4.0 ng/ml by the Hybritech monoclonal assay. Nine per cent of patients fell between 7.4 and 18.4 ng/ml by the polyclonal assay (4.1-10 ng/ml by the monoclonal assay) and 2% had polyclonal PSA levels > 18.4 ng/ml (> 10 ng/ml by the monoclonal assay). Cancer detection rates (influenced by the percentage of patients undergoing biopsy) were 0.3% in patients with polyclonal PSA levels < or = 2.5 ng/ml, 1.2% in patients < or = 7.3 ng/ml, 20.9% between 7.4 and 18.4 ng/ml, and 50% of those > 18.4 ng/ml; the overall cancer detection rate was 3.8%. CONCLUSIONS: These data support the use of higher PSA levels as a criterion for further evaluation in screening for prostate cancer and establish the frequency distribution of PSA in a screening population when the Yang assay is used.

Adult↗

PubMed1994

Prostate specific antigen as a predictor of an abnormal digital rectal examination.

OBJECTIVE: To assess the ability of serum prostate specific antigen (PSA) to predict and differentiate patients with normal and abnormal digital rectal findings. SUBJECTS AND METHODS: A prospective analysis of 1374 participants in a prostate cancer screening programme was performed. After completion of a questionnaire including age and voiding symptoms as well as phlebotomy for PSA analysis, digital rectal examination was performed and the findings were categorized with respect to size, consistency, symmetry and nodularity. RESULTS: In men less than 50 years of age the mean serum PSA level failed to discriminate any of the digital rectal examination categories. In men over 50 there was a statistically significant difference in mean PSA levels between symmetrical, normal sized prostates and symmetrically enlarged glands as well as between symmetrical, normal sized and abnormal prostates (P < 0.05). No statistically significant difference was found in mean serum PSA levels between symmetrically enlarged prostate glands and those with palpable nodules. PSA levels < or = 2.5 ng/ml (normal range for the Yang polyclonal assay) and < 7.4 ng/ml (corresponding to the normal range of < 4.0 ng/ml for the Hybritech monoclonal assay) demonstrated a probability of an abnormal digital rectal examination of 11% and 14% respectively. PSA levels > 18.4 ng/ml (corresponding to monoclonal levels of > 10 ng/ml) had a 67% probability of an abnormal digital rectal examination. However, moderate elevations in PSA could not be used to predict digital examination abnormalities due to the high incidence of moderate PSA elevations associated with symmetrical enlargement of the prostate. CONCLUSIONS: Serial annual PSA measurements may provide an alternative means of screening men over 50 years of age. Contamination of results with PSA elevation due to benign prostatic hyperplasia remains, however, a problem.

Adult↗

PubMed1994

Transrectal ultrasound in the evaluation of rhabdomyosarcoma involving the prostate.

OBJECTIVE: To evaluate transrectal ultrasound as a means of diagnosis and of monitoring patients with rhabdomyosarcoma involving the prostate. PATIENTS AND METHODS: Serial transrectal ultrasonography was utilized to evaluate prostatic rhabdomyosarcoma in three patients. RESULTS: Unlike prostatic adenocarcinoma and transitional cell carcinoma involving the prostate, which are predominantly hypoechoic, the echogenicity of rhabdomyosarcoma is similar to that of the normal prostate. Transrectal ultrasound provided a simple means of monitoring prostate size and sampling tissue in these patients. CONCLUSION: Transrectal ultrasound imaging can be useful in both diagnosis and evaluation of treatment response as well as provide easy access for biopsies in patients with rhabdomyosarcoma involving the prostate.

Adolescent↗

PubMed1993

Efficacy of transrectal ultrasound-guided seminal vesicle biopsies in the detection of seminal vesicle invasion by prostate cancer.

Detection of microscopic seminal vesicle invasion with prostate cancer by transrectal ultrasound-guided seminal vesicle biopsies provides a method of evaluation that is much less subjective than digital rectal examination or imaging techniques. The accuracy of seminal vesicle biopsy is analyzed in 73 patients undergoing transrectal ultrasound-guided biopsy of 145 seminal vesicles followed by radical prostatectomy. Of 133 benign seminal vesicle biopsies 11 (8.3%) were found in the surgical specimen to have cancer involving an average of 6% of the seminal vesicle area. Of 8 seminal vesicle biopsies showing cancer adjacent to seminal vesicle epithelium 100% demonstrated seminal vesicle invasion in the surgical specimen extending for an average of 19% of the seminal vesicle area. Three biopsies exhibited cancer but no seminal vesicle epithelium; only 1 (33%) of these had seminal vesicle invasion for 5% of the seminal vesicle area. One biopsy revealed normal prostate tissue. Careful placement of bilateral biopsy sites cephalad to the prostate base (not traversing any portion of the prostate gland) is recommended. Caution should be exercised when basing treatment decisions on seminal vesicle biopsies that do not reveal seminal vesicle epithelium histologically.

Aged↗

PubMed1992

Detection of clinically significant prostate cancer by transrectal ultrasound-guided systematic biopsies.

Systematic biopsies are a useful, sensitive means to detect carcinoma of the prostate. However, multiple biopsies pose a risk for detecting clinically insignificant prostate cancer, that is those cancers less than 0.5 cc in volume, which occur in approximately 32% of all white men more than 50 years old. Systematic biopsies were positive for cancer in 442 of 816 patients and 60 (14%) demonstrated only a minute focus of cancer (3 mm. or less) in 1 of the 6 biopsy specimens. In 27 patients with these minute foci who underwent radical prostatectomy a wide range of cancer volumes was observed; 30% of these 27 cancers were less than 0.5 cc (15% less than 0.2 cc) and may not have required therapy. Thus, the overall risk of detecting an insignificant cancer is 4.0% with systematic biopsies. Performance of confirmatory biopsies in patients with a minute focus (3 mm. or less) of cancer on initial systematic biopsies resulted in cancers less than 0.5 cc being removed in only 1 of 10 radical prostatectomies (10%, none was less than 0.2 cc). Thus, with the addition of confirmatory biopsies the risk of detecting insignificant cancer is 1.4%. Conservative management is recommended for patients without significant cancer on repeat biopsies in whom initial biopsies have revealed only a minute focus of cancer in 1 of the biopsy cores. We believe that concern is also warranted for patients who have 3 mm. or less of cancer demonstrated by several nonsystematic biopsies directed at a suspicious hypoechoic lesion in whom the digital rectal examination is normal.

Antigens, Neoplasm↗

PubMed1992

Estimation of prostate cancer volume by transrectal ultrasound imaging.

Estimation of prostate cancer volume is a potentially important application of transrectal ultrasound imaging. Preoperative volume estimation was performed in 110 patients undergoing transrectal prostatic ultrasonography and subsequent radical prostatectomy. Several different methods for calculation of cancer volume were compared. Most of the sonographic methods that have proved to be useful for estimation of prostate gland volume were inaccurate in estimation of the cancer volume in the prostatectomy specimen. All methods underestimated the cancer volume in the majority of the cases. Step-section planimetry provided the highest correlation with cancer volume (r = 0.84) but the wide range of error makes clinical application impractical. With the current technology, ultrasound imaging alone does not appear to be a useful means to predict cancer volume.

Aged↗

PubMed1992

Transrectal ultrasound imaging and ultrasound guided prostate biopsies in the detection of residual carcinoma in clinical stage A carcinoma of the prostate.

Planning treatment for patients diagnosed with stage A prostate cancer by transurethral resection or open enucleation can be difficult. Inability to determine the presence or absence of significant residual disease can result in unnecessary treatment for some individuals and inadequate treatment in others. Transrectal ultrasound imaging and systematic prostate biopsies offer a potential means of evaluating these patients. To determine the rate of residual cancer detection 3 groups of stage A prostate cancer cases were evaluated. Group 1 consisted of 39 patients who underwent radical prostatectomy. Preoperative ultrasound imaging revealed residual cancer in only 24%. Transrectal ultrasound guided systematic biopsies were performed in group 2 (25 patients) and revealed cancer in only 28%. Based on prior morphometric studies of prostatectomy specimens from stage A cases, a modification of the systematic biopsy method, which included anteriorly directed biopsies, was developed and applied to group 3 (47 patients). Cancer was detected in 47% of the patients, and it was detected by additional anterior biopsies alone in 11%.

Adenocarcinoma↗

PubMed1991

Culture of prostatic epithelial cells from ultrasound-guided needle biopsies.

A protocol which was developed for the culture of epithelial cells from radical prostatectomy specimens was slightly modified to permit the culture of cells from ultrasound-guided prostatic needle biopsies. The collagenase digestion step of the standard protocol was omitted, and biopsies were simply minced and allowed to attach to collagen-coated dishes in serum-free medium. Cell outgrowths from biopsies were free of fibroblasts, and expression of keratin, prostate specific antigen, and prostatic acid phosphatase was maintained in vitro. The establishment of a bank of frozen cells from primary cultures permitted repetitive studies with individual cell strains, which could be serially passaged and were capable of clonal growth. The ability to derive cultures from biopsies will facilitate the biological characterization of cells from primary prostate tumors of high malignant grade, which are not commonly available from radical prostatectomy specimens.

Acid Phosphatase↗

PubMed1991

Efficacy of transrectal ultrasound for identification of clinically undetected prostate cancer.

A total of 51 patients underwent transrectal ultrasound of the prostate before radical cystoprostatectomy for transitional cell carcinoma of the bladder. Each had a normal prostate by digital rectal examination, no history of prostatic adenocarcinoma and no invasion of the prostate by transitional cell carcinoma. Real-time and step-sectioned ultrasound images were interpreted at the time of sonography and results were compared to pathological examination of the step-sectioned prostate specimen. When adenocarcinoma was identified in the specimen, cancer volume was determined. Positive ultrasound scans consisted of those exhibiting hypoechoic lesions. Hypoechogenicity due to transurethral resection defects, benign hyperplasia, vascular structures or shadowing from calcifications was not considered positive. Of 51 patients 27 (52.9%) exhibited no abnormality on ultrasound and were free of cancer in the prostate specimen, while 8 (15.7%) demonstrated a hypoechoic lesion that was proved to be prostate cancer. Seven patients (13.7%) with normal transrectal ultrasound scans had adenocarcinoma of the prostate, while 9 (17.6%) had lesions on ultrasound but no cancer. Based on these results, transrectal ultrasound has a sensitivity of 53.3% and a specificity of 75%. Further analysis reveals that transrectal ultrasound is more accurate in the detection of cancers of greater than 0.20 cc in volume than those of 0.20 cc or less. Transrectal ultrasound also is more accurate in the detection of peripheral zone than transition zone cancers.

Adult↗