Biomedical subjects

N N Stone

Publications and source records attributed to N N Stone.

At least 73 records · Page 4Linked to original sources

PubMed1993

Bladder rupture associated with pelvic fracture due to blunt trauma.

A total of 103 patients with pelvic fracture due to blunt trauma were evaluated by cystography and 10 cases of bladder rupture were identified. Risk factors associated with the likelihood of bladder rupture included gross hematuria, the number of fractured pubic rami, tachycardia, hypotension, and declining hematocrit. We conclude that since 90 percent of the patients do not have bladder rupture when a pelvic fracture is encountered, cystography may be safely reserved for those patients with pelvic fracture who are considered to be at high risk for such an injury.

Adolescent↗

PubMed1993

Renal angiomyolipoma associated with neurofibromatosis and primary carcinoid of mesentery.

A patient with von Recklinghausen's disease manifested by dermal neurofibromatosis and cafe-au-lait spots presented with complaints of malaise, weight loss, lower extremity weakness, and a palpable left lower abdominal quadrant mass. Evaluation revealed a lumbar neurofibroma, a localized primary carcinoid tumor of the mesentery, and a left renal angiomyolipoma. Although an association between neurofibromatosis and carcinoid has been previously reported, we believe this is the first report documenting the association of all three entities.

Carcinoid Tumor↗

PubMed1993

Laparoscopic retroperitoneal lymph node dissection in stage A nonseminomatous testis cancer.

Open retroperitoneal lymph node dissection in clinical Stage A testis cancer offers the advantages of definitive staging and high cure rates. Observation is elected in various settings to avoid the morbidity and possible sequelae of this procedure. We present a case report of a new procedure, laparoscopic retroperitoneal lymph node dissection, that decreases hospital stay, recovery time, and morbidity while maintaining the advantages of open retroperitoneal lymph node dissection.

Adult↗

PubMed1993

Covered exstrophy with sequestered colonic remnant.

We report on a woman who presented with urinary incontinence, covered exstrophy and an abdominal mass. Radiographic studies and cystoscopy confirmed that the anterior abdominal mass did not communicate with the bladder or colon and that the gastrointestinal tract was normal. Subsequent surgical resection of the mass and Young-Dees-Leadbetter bladder neck reconstruction were performed. Histological examination of the mass revealed colonic mucosa. The etiology of the covered exstrophy and sequestered colonic remnant is discussed.

Abnormalities, Multiple↗

PubMed1993

Isograft bladder mucosal transplantation for hypospadias repair in identical twins.

Urethral reconstruction with a bladder mucosal free graft offers several advantages for patients with complex hypospadias. We report a case in which identical twins circumcised at birth presented with mid-shaft hypospadias and chordee. A bladder mucosa graft was harvested from 1 twin, divided and used to form 2 neourethras. The donor twin underwent hypospadias repair, followed immediately by repair in the second twin with the isograft neourethra. To our knowledge this is the first reported case of bladder mucosal transplantation for hypospadias repair.

Child, Preschool↗

PubMed1993

A spermatic cord hematoma secondary to varicocele rupture from blunt abdominal trauma: a case report and review.

Varicocele is a relatively common entity that is mostly studied because of the effects on the testes and a presumed role in infertility. Hemorrhage secondary to a varicocele, however, is a known but rare morbidity. A case is presented of a ruptured varicocele due to blunt abdominal trauma with a sudden increase in intra-abdominal pressure with transmission to the varicocele. Such a mechanism may also provide an explanation for the occurrence of a more commonly recognized phenomenon of idiopathic spermatic cord hematoma.

Abdominal Injuries↗

PubMed1993

Prostate Cancer Awareness Week, 1992: a summary of key findings.

Prostate Cancer Awareness Week was begun in 1989 to investigate whether men could be recruited to participate in free prostate cancer screening. Initially designed to raise public awareness of "the ignored male disease", it has become the largest single cancer screening program in the United States. In 1992, more than 500,000 men were examined by digital rectal examination (DRE) and more than half of these also by measuring prostate-specific antigen (PSA). Although the populations examined have been generally better educated than the national average, predominantly white, and typically (> 40%) experiencing some symptom of prostate disease, adherence to annual prostate examinations remains low among successive cohorts of participants. Prostate cancers detected through this program exhibit a more favorable stage distribution than the national average. From 1989 through 1992, many cancers were detected by using the effective combination of DRE and PSA testing, which resulted in more stage A disease being diagnosed and fewer stage B, C, and D tumors. Data from 1992 suggest that increasing sophistication is possible with PSA test results, and age-specific PSA reference ranges have been developed.

Adult↗

PubMed1992

Treatment options in benign prostatic hypertrophy.

Surgery remains the first choice in patients with progressive urinary symptoms. Medical therapy--with antiandrogens, 5 alpha-reductase inhibitors, or alpha-adrenergic antagonists--may be useful in selected cases.

5-alpha Reductase Inhibitors↗

PubMed1990

Recurrent urethral stricture disease managed by clean intermittent self-catheterization.

We studied 41 patients with urethral stricture who had failed at least 1 operation, and were being maintained with filiform and follower dilation every 6 to 12 weeks. The patients were instructed in clean intermittent self-catheterization with a 16F red rubber catheter, which was performed every 1 to 30 days. Followup from 9 to 36 months revealed excellent compliance and average peak uroflow rates increased from 5.5 cc per second before dilation to 17.1 cc per second at the last followup visit. Clean intermittent self-catheterization is a simple method to maintain a patent urethra and obviates the need for further operations or painful dilations.

Follow-Up Studies↗

PubMed1989

Flutamide in treatment of benign prostatic hypertrophy.

A multicenter, randomized, double-blind study was undertaken to evaluate the efficacy of the antiandrogen flutamide in treating patients with urinary obstruction caused by benign prostatic hypertrophy (BPH). Patients were randomized to either flutamide (750 mg/d) or a placebo. Prostate size (measured by ultrasound), uroflow, and symptomatology were assessed in all patients. Of the 84 patients entered in the study, 30 receiving placebo have, to date, reached twelve weeks and 4 have reached twenty-four weeks. Twenty-eight patients receiving flutamide have reached twelve weeks, while 8 have reached twenty-four weeks. At twenty-four weeks, a 41 percent median decrease in prostate volume and a 46 percent increase in full-bladder uroflow was observed in patients receiving flutamide; no significant changes in prostate volume or uroflow occurred in patients receiving placebo. However, significant symptomatic improvements were noted in both groups. Only 4 patients (11%) had significant adverse reactions to flutamide; these reactions included breast pain and diarrhea. No cases of impotence occurred. It was concluded that flutamide may be a safe and effective drug for the treatment of symptomatic BPH.

Anilides↗

PubMed1989

Bilateral ureteral obstruction: an unusual complication of pancreatitis.

A case of bilateral ureteral obstruction associated with alcoholic pancreatitis in a 40-yr-old male patient is reported. Although pancreatitis complicated by pseudocyst formation has been known to involve intra- and extraabdominal organs, bilateral ureteral obstruction has not been reported. We postulated that in the case reported herein, periureteral fat necrosis involving both ureters was the primary etiological mechanism.

Adult↗

PubMed1988

Bilateral ureteral necrosis and obliteration secondary to pancreatic pseudocyst.

We report an unusual case of bilateral distal ureteral necrosis and obliteration associated with a pancreatic pseudocyst. After cyst drainage bilateral ureteral obstruction developed, requiring surgical correction. While it is known that a pancreatic pseudocyst can cause extensive damage to contiguous organs, to our knowledge this case represents the first report of ureteral necrosis and obliteration resulting from pancreatic enzyme damage to the ureters.

Fat Necrosis↗

PubMed1988

Controversies in urologic oncology.

The persistent controversies that characterize urologic oncology reflect the significant advances that have been made in our understanding of genitourinary malignancy and the objective posture that has been taken both by those active in this area and by those whose interests are more indirect. Ultimately, the beneficiaries of these controversies are the patients and their physicians. As continued problems are recognized and investigations are designed to explore them, controversy and skepticism become a healthy concomitant so that true knowledge and understanding can be achieved and such issues ultimately resolved.

Carcinoma in Situ↗

PubMed1987

Aromatization of androstenedione to estrogen by benign prostatic hyperplasia, prostate cancer and expressed prostatic secretions.

Human prostatic tissue and expressed prostatic secretions (EPS) from patients with benign prostatic hyperplasia (BPH) and prostate cancer were incubated with (1 beta 3H) androstenedione. The extent of aromatization was determined by measuring the transfer of 3H from the 1 beta position into water. The amount of 3H2O recovered corresponds to the estrogens formed. Tissue from 5 patients with BPH yielded 2.13 (+/- 1.05) pmol/mg protein/h while the EPS from the same patients yielded 727 fmol/mg protein/h. In patients with prostate cancer the mean formation of estrogens was 388 fmol/mg protein/h (+/- 75). 4-hydroxy-androstenedione, an aromatase inhibitor, successfully inhibited aromatization in BPH and prostate cancer 53-98%.

Androstenedione↗

PubMed1987

Hypogonadism in Prader-Willi syndrome.

Prader-Willi syndrome is characterized by eating abnormalities, infantile hypotonia, obesity, mental retardation, and hypogonadism. The causation of hypogonadism varies. We describe a patient with Prader-Willi syndrome whose hypogonadism is secondary to a hypothalamic defect. Individualization of patients with this syndrome is suggested. Based on the particular hormonal abnormality identified, a treatment plan can be constructed. Cryptorchidism should be approached in the usual fashion.

Adult↗

PubMed1986

Estrogen formation in human prostatic tissue from patients with and without benign prostatic hyperplasia.

Prostatic tissue removed at the time of cystoprostatectomy was separated into periurethral and peripheral zones. Homogenized tissue was incubated with [1,2,6,7(3)H] androstenedione in the presence or absence of an aromatase inhibitor, 4-hydroxyandrostenedione (4-OHAD) and a 5 alpha-reductase inhibitor 4-MA (N,N-diethyl-4-methyl-3-oxo-4-aza-5 alpha-androstane 17 beta-carboxamide). Estrogen formation was determined by reverse isotope dilution of [3H] estrone and [3H] estradiol and crystallization to constant specific activity. Control incubations were carried out in parallel utilizing heated prostatic tissue. Total estrogens produced in the periurethral zone in patients with benign prostatic hyperplasia (BPH) was 223 fmol/mg protein/hr (SE +/- 57) compared to 102 fmol (SE +/- 17) in patients without BPH. Estrogen formation in the peripheral zone was 175 fmol (SE +/- 69) and 105 fmol (SE +/- 26) in patients with and without BPH, respectively. The prostatic aromatase exhibits Michaelis-Menton kinetics with an apparent Km of 90 nM. 4-OHAD inhibited aromatization in the prostatic tissue by 57-93%. Aromatization was also strongly inhibited by 4-MA, indicating that 4-MA is a potent aromatase as well as a 5 alpha-reductase inhibitor in this tissue. These results suggest that aromatization of androgens to estrogens in the human prostate proceeds at a substantial rate and that local estrogen formation could preexist and be a factor in the etiology of BPH and prostatic cancer.

Adult↗

PubMed1985

Renal capsular lipoma.

Renal capsular lesions are rare. Selective angiography remains the best means to identify a suspected capsular mass. We report a case of renal capsular lipoma and review the radiographical findings.

Angiography↗

PubMed1984

Mineralocorticoid excess secondary to adrenal cortical carcinoma.

Adrenal cortical carcinoma may present solely with a syndrome of mineralocorticoid excess. Primary aldosteronism, resulting from adrenal carcinoma, is unusual and has only been reported rarely. A review of the literature revealed 19 cases with marked hypertension and hypokalemia, resulting from mineralocorticoid excess produced by adrenal cortical carcinoma. We report an additional case that supports the hypothesis that adrenal carcinoma may mimic hyperaldosteronism. Extensive assay of adrenal function will demonstrate the presence of biologically inactive steroids, suggesting the presence of adrenal cortical carcinoma.

Adrenal Cortex↗