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Biomedical subjects

P M Livne

Publications and source records attributed to P M Livne.

At least 37 records · Page 2Linked to original sources
PubMed1999

Predictive value of urinary cultures in assessment of microbial colonization of ureteral stents.

BACKGROUND AND PURPOSE: Bacterial colonization of indwelling ureteral stents may serve as a nidus for bacteriuria in operations where stents are manipulated. The predictive value of urine cultures in the assessment of stent colonization was examined in 65 patients with indwelling ureteral stents. PATIENTS AND METHODS: Prophylactic antibiotic treatment was administered prior to stent insertion. All patients were ambulatory at the time of investigation and were examined in the outpatient clinic. Urine cultures were taken prior to stent removal after 8 to 150 (mean 64) days. The stents were removed under aseptic conditions, and the proximal and distal ends were cut off and placed in a culture medium for evaluation. None of the patients was treated for urinary tract infection prior to stent removal. RESULTS: Bacteriuria was found in 15% of the patients. In 35 patients (54%), urine and stent cultures were sterile. In 20 patients (31%), the urine culture was sterile but the stent was colonized (Enterococcus 9, E. coli 5, Staphylococcus aureus 2, S. epidermidis 2, Candida 1, Citrobacter diversus 1). One patient had a sterile stent culture with bacteriuria. In 9 patients (13.5%), urine and stent cultures were identical (E. coli 4, Pseudomonas 4, Candida 1). The incidence of stent colonization did not correlate with stent dwelling time. The sensitivity of urine cultures for the detection of stent colonization was poor, being 31% only. In a specific patient with negative urine culture, the probability of stent colonization was 36%. CONCLUSION: A sterile urine culture does not rule out the stent itself being colonized. Therefore, patients with indwelling ureteral stents and a sterile urine culture may benefit from prophylactic antibiotic treatment prior to endourologic procedures. The prophylactic regimen must provide coverage for common gram-negative uropathogens as well as gram-positive bacteria, including enterococci.

Adult↗
PubMed1998

Involution rate of multicystic renal dysplasia.

OBJECTIVE: To document the involution rate and long-term results of management of multicystic dysplastic kidney. MATERIALS AND METHODS: Data were collected retrospectively for all 23 infants (16 boys) with multicystic dysplastic kidney who were treated at our center over the last 19 years (1977-1995). The diagnosis was based on prenatal ultrasound in 18 patients and on palpable abdominal mass in 5, and confirmed in all patients by postnatal ultrasound and radioisotope scan. Voiding cystography was performed in 18 patients to exclude vesicoureteral reflux. Mean follow-up was 46 months (range, 3 months to 5 years) and included serum creatinine measurements and renal ultrasonography. RESULTS: Two groups of patients were identified. Ten (43.6%) with other urologic abnormalities (group A) and 13 patients without other urologic abnormalities (group B). Vesicoureteral reflux was observed in 4 patients. Nephrectomy was performed in 4 patients, all from group B. The other 19 patients were treated conservatively. Complete involution was observed in 8 patients in group A and 6 in group B after a mean follow-up period of 9.2 and 10 months, respectively. Two patients, 1 from each group, later underwent nephrectomy not because of no involution but because of an increase in the size of the kidney involved. CONCLUSION: Patients with multicystic renal dysplasia have significant associated urologic malformations, and the natural history of the disease is unpredictable. All patients require appropriate investigation of the urinary tract and long-term follow-up. The most outstanding finding of the study is the much higher involution rate of multicystic renal dysplasia and the rate of associated urologic abnormalities than that reported in the literature. Surgery remains an option for the patients in the absence of no involution. multicystic dysplastic kidney, surgery, conservative.

Abnormalities, Multiple↗
PubMed1996

Increased renal function in kidneys with ureteropelvic junction obstruction: fact or artifact? Assessment by quantitative single photon emission computerized tomography of dimercapto-succinic acid uptake by the kidneys.

PURPOSE: We evaluated whether increased differential renal function on the pentetic acid (DTPA) renogram represents elevated renal function in obstructed kidneys. MATERIALS AND METHODS: In 10 patients with unilateral ureteropelvic junction obstruction and a differential function of 53% or greater on the DTPA renogram of the obstructed kidney we performed quantitative single photon emission computerized tomography of dimercapto-succinic acid uptake by the kidneys. RESULTS: The absolute uptake of dimercapto-succinic acid was significantly higher in the obstructed kidneys compared to the contralateral normal kidneys (30.0% +/- 7.8 versus 25.3% +/- 8.2, t = 3.6, p < 0.01, respectively). The elevated absolute uptake in the obstructed kidneys was due to an increased functional volume compared to the contralateral normal kidneys (126.0 +/- 69.7 cc versus 102.3 +/- 59.2 cc, t = 4.4, p < 0.01, respectively). CONCLUSIONS: The results suggest that increased relative renal function in hydronephrotic kidneys due to ureteropelvic junction obstruction is not an artifact of the DTPA renogram. It may represent a compensatory mechanism that sometimes may overcompensate resulting in a paradoxical hyperfunctioning kidney.

Adult↗
PubMed1996

Type II ureteral triplication associated with ectopic ureter.

We report a case of type II ureteral triplication associated with ectopic ureter. The ureter, draining the upper renal segment, entered the vagina, and the other two ureters, draining the middle and lower renal segments, had joined and entered the bladder. The anatomic findings are compatible with those predicted by the Weigert-Meyer law. A thorough evaluation of such an anomaly is essential for effective management.

Abnormalities, Multiple↗
PubMed1996

Dismembered pyeloplasty in children with and without stents.

OBJECTIVES: To assess the benefit of performing nonstented pyeloplasty in infants. METHODS: Forty-eight consecutive pyeloplasties were performed by two surgeons using different techniques, from 1987 to 1992. One used stents in all cases (23) and the other performed a nonstented anastomosis with external drainage (25 cases). Patients with specific indications for internal drainage, i.e. poor renal function, extreme pyelocaliectasis, were excluded from the study. Parameters of cost and complications were assessed. RESULTS: The group with stents had more febrile episodes, needed more antibiotics and were hospitalized twice as long as the nonstented group. Pre- and postoperative renal function was similar in both groups. CONCLUSIONS: Performing pyeloplasties in children without stenting the anastomosis is safe and cost-effective.

Adolescent↗
PubMed1996

Detection of permanent damage in kidneys with vesicoureteral reflux by quantitative single photon emission computerized tomography (SPECT) uptake of 99mtechnetium labeled dimercaptosuccinic acid.

PURPOSE: We determined the level of functional damage to the kidney which inhibits further growth. MATERIALS AND METHODS: Renal functional volume and percent uptake of 34 kidneys with reflux were studied by performing sequential quantitative single photon emission computerized tomography 2 times at a mean interval of 3.2 years. RESULTS: Change in volume between the initial and repeat studies was 27.2 +/- 28.4% in all 34 kidneys. Change in volume was less than 7% in 8 kidneys and greater than 14% in 26. Receiver operating characteristic curve analysis indicated that 15.6% kidney uptake was associated with 75% sensitivity, 100% specificity and 94% accuracy in distinguishing kidneys with more than 7% from those with less than 7% change in volume. The value of kidney uptake of less than 15.6% was 100% in predicting less than 7% change in volume (positive predictive value) and the value of kidney uptake greater than 15.6% was 93% in predicting more than 7% change in volume (negative predictive value). CONCLUSIONS: Kidney uptake of less than 15.6% represents irreversible impairment of renal growth and indicates permanent damage in kidneys with vesicoureteral reflux.

Adolescent↗
PubMed1996

Polyneuropathy in impotence.

Three hundred and forty-one consecutive impotent patients were evaluated for the presence of polyneuropathy (PNP) by neurophysiological and psychophysical tools, including nerve conduction and quantitative sensory tests (thermal and vibratory). PNP was present in 38% of diabetics, and 10% of non diabetics. Overall, PNP was found in 19% of impotent patients. PNP is relatively common among impotent patients, and might play a causative role. Patients judged 'neurogenic' and those judged 'vasculogenic', based on nocturnal tumescence test (NPT) and vasoactive drug injection tests, had very similar rates of PNP (21 and 23%, respectively). Thus it is suggested that the vasoactive drug injection test does not serve in discriminating neurogenic from non-neurogenic impotence. NPT, however, faithfully discriminates psychogenic from organic impotence, as far as PNP is involved, since a very low percentage of patients with normal NPT had PNP.

Adolescent↗
PubMed1994

Results of conservative management of clinically localized prostate cancer.

BACKGROUND: The selection of treatment for patients with localized prostate cancer requires reliable information about the outcome of conservative management. Previous studies of this question are generally considered unreliable because they were uncontrolled and nonrandomized. METHODS: We performed a pooled analysis of 828 case records from six nonrandomized studies, published since 1985, of men treated conservatively (with observation and delayed hormone therapy but no radical surgery or irradiation) for clinically localized prostate cancer. A Cox regression analysis was performed to determine which factors influenced survival among patients who did not die of causes other than prostate cancer (disease-specific survival). Kaplan-Meier curves for overall and metastasis-free survival among such patients were compared with use of the log-rank method and the Mantel-Haenszel test. RESULTS: Factors that had a significant effect on disease-specific survival were grade 3 tumors (risk ratio, 10.04), residence in Israel (risk ratio, 2.48) or New York (risk ratio, 0.37), and age under 61 years (risk ratio, 0.32). Ten years after diagnosis, disease-specific survival (with data on men who died from causes other than prostate cancer censored) was 87 percent for men with grade 1 or 2 tumors and 34 percent for those with grade 3 tumors; metastasis-free survival among men who had not died of other causes was 81 percent for grade 1, 58 percent for grade 2, and 26 percent for grade 3 disease. These findings were not affected by the inclusion of men who had early-stage cancer, were older, had worse-than-average health, or underwent delayed radiation therapy or radical prostatectomy. CONCLUSIONS: The strategy of initial conservative management and delayed hormone therapy is a reasonable choice for some men with grade 1 or 2 clinically localized prostate cancer, particularly for those who have an average life expectancy of 10 years or less. New treatment strategies are needed for men with grade 3 prostate cancer.

Aged↗
PubMed1994

Clinical outcome and follow-up of prenatal hydronephrosis.

Between 1987 and 1991, 160 hydronephrotic kidneys were diagnosed prenatally and confirmed postnatally in 100 infants. The aim of the study was to describe the natural history and management of primary hydronephrosis detected prenatally. We devised a new classification of obstructive uropathy outcome using ultrasonography and the diethylenetriamine penta-acetic acid scan. Accordingly, we classified the patients as having mild, moderate or severe hydronephrosis. Nine patients had pyeloplasties and 5 had ureteric reimplantations. We conclude that in most cases there is no need for immediate surgery, and that the initial approach to the management of congenital hydronephrosis should be conservative. We suggest that anti-bacterial prophylaxis be conventionally given to infants with vesicoureteral reflux and for the first 6 months of life to infants demonstrating moderate to severe newborn primary hydronephrosis.

Female↗
PubMed1994

Evaluation of prenatally diagnosed hydronephrosis by morphometric measurements of the kidney.

A large number of hydronephrotic kidneys (108) were diagnosed prenatally in 69 infants between 1987 and 1991 and subsequently confirmed postnatally. Prenatal morphometric measurements were done in order to find reliable parameters for the detection of a group at risk for surgical treatment. A second aim of the study was to describe the natural history and management of hydronephrosis detected prenatally. We devised a classification of postnatal obstructive uropathy using ultrasonography and the renal scan. Accordingly, we classified the patients as having mild, moderate or severe hydronephrosis. A renal pelvic antero-posterior diameter (APD) of 9 mm or more, and a pelvic-to-renal APD ratio of 0.45 before 32 weeks of gestation and 0.52 thereafter, were found to be useful for the detection of severe outcome. Our new parameter, a pelvic-to-renal volume ratio of greater than 0.08, can also be used for this purpose.

Algorithms↗
PubMed1994

Increased levels of a 21-kDa protein in the circulation of tumor-bearing patients.

A novel non-ras 21-kDa protein (p21) was detected in sera of cancer patients by enzyme-linked immunosorbent assay (ELISA), using polyclonal anti-p21 antibodies. While only 4.6% of the healthy donors (n = 43) showed p21 serum levels higher than the mean +/- 2 SD of the normal group, 33 to 80% of the cancer patients (n = 94) with various tumors were positive in the ELISA test. In particular, patients with malignant lymphoma, urogenital, and gastrointestinal tumors had a 2.8- to ninefold increase in p21 serum levels. Elevated serum levels were also found in patients with benign prostatic hyperplasia (3.2-fold increase). In 17 out of 22 patients with urogenital tumors, changes in serum p21 levels correlated with the clinical course of the disease. In 15 patients, a favorable response to therapy was correlated with a decline in serum p21 level. Two patients with renal cell carcinoma showed increased or persistently high levels of p21 after surgery and were subsequently found to have distant metastases. Expression of p21 in ten renal cell carcinoma tissues was determined by Western blotting. There was a trend toward a higher content of p21 in the less-differentiated tumor tissues. In conclusion, p21 may be a useful indicator in monitoring the outcome of treatment in patients with various malignant tumors. In patients with renal cell carcinoma, p21 serum levels may be of particular importance because no other tumor marker is available.

Adult↗
PubMed1994

Quantitative SPECT of technetium-99m-DMSA uptake in the kidneys of normal children and in kidneys with vesicoureteral reflux: detection of unilateral kidney disease.

UNLABELLED: Quantitative SPECT was used to evaluate renal functional volume (cc), percent of injected dose/cc (%ID/cc) and renal uptake (%) in 11 children with unilateral vesicoureteral reflux grade 3 or greater, and in 19 normal control children without reflux. METHODS: Studies were performed 4-6 hr after intravenous injection of 0.750-2 mCi of 99mTc-DMSA. RESULTS: Control kidneys (n = 38) had a volume of 99.7 +/- 29.5 cc. The %ID/cc was 0.27 +/- 0.08, and the uptake in one kidney was 24.8% +/- 3.9%. Global renal uptake (right plus left) was 49.6% +/- 7.3%. Functional volume of the control kidneys showed an increase with age, and the %ID/cc showed a steeper decrease with age, resulting in a trend of the kidney uptake to decrease with age. Kidneys with reflux had a decreased kidney uptake of 15.7% +/- 29.5%, compared to age- and sex-matched controls (t = 4.7, p < 0.001). The contralateral kidneys without reflux had a significantly increased total uptake of 33.4% +/- 6.8% as compared to controls (t = 3.44, p < 0.01). Global uptake by the kidneys was 49.2% +/- 8.6% and was not statistically different from controls (t = 1.0, ns). CONCLUSION: Our results suggest that SPECT quantitation of 99mTc-DMSA uptake in each kidney separately could be used as a noninvasive method to assess impairment and compensation of the function of the individual kidney in children with vesicoureteral reflux.

Aging↗
PubMed1993

Squamous cell carcinoma of the prostate.

A case of the rare squamous carcinoma of the prostate is herein presented. Squamous cancer accounts for 0.5-1% of prostatic malignancies. The patient died of systemic metastases 5 months after diagnosis. Review of the literature suggests that such a cancer is highly aggressive and responds poorly to any mode of therapy, perhaps because of a different cell of origin.

Aged↗
PubMed1993

Bilateral asynchronous renal cell carcinoma: treatment approach.

Two hundred patients underwent nephrectomy for renal cell carcinoma (RCC) at our service in 1978-89. During follow-up four patients developed RCC in the remaining kidney and underwent a parenchymal preserving procedure as curative treatment (one enucleation, and three partial nephrectomies). The interval between the nephrectomy and the diagnosis of asynchronous RCC was 50-84 months (mean 65 months). None of the patients needed dialysis after the operation, and creatinine level in all remained between 1.6 and 1.9 mg. One patient died from a heart attack 8 years after the partial nephrectomy, two patients have no evidence of disease 24 months and 76 months after enucleation and partial nephrectomy, respectively. The fourth patient, who had resection of metastatic lesion in the scalp 36 months before the partial nephrectomy, is alive 34 months after the procedure but has lately developed recurrence in the scalp. Although relatively rare, it is important to be aware of the possible asynchronous development of RCC in the contralateral kidney after nephrectomy for RCC. In such cases, parenchymal preserving procedure (enucleation, partial nephrectomy) is an alternative that should be considered to improve the quality of life and to avoid the need for dialysis.

Aged↗
PubMed1990

Re-orchiopexy: advantages and disadvantages.

Re-orchiopexy was performed in 33 boys (42 testes) in order to place an undescended testis in the scrotum after failure of the initial operation. Success was achieved in 80.9%. Seven of the 10 testes, reported to have short spermatic vessels at the first surgery, had no elongation of the vessels and only 1 of these resulted in a high scrotal location of the testis. It appears that most orchiopexy failures are the result of technical failures of the initial procedure. Standard orchiopexy with extensive mobilization of the spermatic vessels and testis can successfully correct most of the undescended testes. However, the preferred management for the intra-abdominal testis with short vessels may be transection of the spermatic vessels rather than a planned two-stage technique.

Adolescent↗
PubMed1990

Extracorporeal shock wave lithotripsy: our experimental and clinical experience with the Direx machine.

The Direx Tripter X-1 is a modular extracorporeal shock wave system that uses underwater spark gaps as its source for lithotripsy. Experience with 712 treatments in 541 patients has given a fragmentation rate of 99%. Of these patients, 27% had stones larger than 2 cm or multiple stones. A stone free situation at 3 months follow-up was achieved in 75% of the cases. Seventeen percent had small fragments less than 4 mm and 8% had fragments greater than 4 mm. Auxiliary procedures following ESWL were required in 7%. No major complications were seen. The advantages of this system are: modularity, mobility, flexibility, and low cost.

Adolescent↗
PubMed1990

Long-term follow-up of patients after pyeloplasty for ureteropelvic junction obstruction.

Between the years 1976 and 1986, 94 patients ranging in age from 2 weeks to 60 years were referred for treatment of ureteropelvic junction obstruction. A dismembered pyeloplasty was performed in 85 patients, ureterocalycostomy in 4 patients and primary nephrectomy in 5 patients. Apart from aberrant vessels found in 14 patients and associated calculi in 12, clinical results were satisfactory in most of the patients (96.2%). The calyceal appearance on the postoperative excretory urogram showed diminution with good drainage in 53.8%, improvement of drainage in 42.3%, and deterioration in 3.8%.

Adolescent↗