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Biomedical subjects

S L Goldenberg

Publications and source records attributed to S L Goldenberg.

68 records · Page 4Linked to original sources
PubMed1989

Palpable prostatic nodules: comparison of US and digital guidance for fine-needle aspiration biopsy.

This study was undertaken to evaluate the use of transrectal sonographically guided fine-needle aspiration biopsy and to compare sonographic with digital guidance for biopsy. In 62 patients in whom prostatic carcinoma was suspected at digital rectal examination, fine-needle aspiration biopsies were performed transperineally under sonographic guidance and transrectally under digital guidance. These patients had 89 nodules, 73 of which were sampled with both techniques. Malignant cells were obtained under digital guidance in 17 of 73 nodules (23%) and under sonographic guidance in 16 (22%). An additional seven nodules, which were not seen sonographically, were sampled under digital guidance and proved to be negative. In nine other nodules that were nonpalpable and evident only with sonography, malignant cells were obtained under sonographic guidance in three. These findings indicate that sonographic guidance for fine-needle aspiration biopsy is as good as digital guidance for palpable lesions.

Adult↗
PubMed1988

Early hydronephrosis following aortic bifurcation graft surgery: a prospective study.

The true incidence and natural history of ureteral obstruction following reconstructive vascular surgery have not been determined previously. A series of 101 patients undergoing aortofemoral and aortoiliac reconstructive surgery were studied prospectively to determine the frequency of hydronephrosis in the first postoperative year. Serial real-time ultrasound examinations were performed preoperatively as well as at 1 week, 3 months and 1 year postoperatively. Ninety-three patients completed the study, with a total of 181 kidneys at risk. Hydronephrosis of mild to moderate degree developed in 15 kidneys (8 per cent) in 11 patients (12 per cent). All patients were asymptomatic, and the obstruction resolved spontaneously in 10 of 11 patients, including 9 within 3 months of onset. Only a single case persisted at 1 year. This study confirms that the hydronephrosis that occurs within the first year after aortic bifurcation graft surgery is not uncommon but it is rarely of clinical significance in the asymptomatic patient.

Aorta, Abdominal↗
PubMed1988

The combination of cyproterone acetate and low dose diethylstilbestrol in the treatment of advanced prostatic carcinoma.

Cyproterone acetate is a steroidal antiandrogen with weak progestational activity that results in the partial suppression of pituitary gonadotropin. We demonstrate that the associated decrease in serum testosterone is more complete and prolonged if cyproterone acetate (200 mg. daily) is combined with a low dose of diethylstilbestrol (0.1 mg. daily). The effectiveness of the combination in the treatment of prostatic carcinoma was investigated in 51 patients with stage D2 malignancy. From an initial concentration of 360 +/- 23 ng. per dl. (mean +/- standard error), serum testosterone decreased to 56 +/- 5 ng. per dl. after 1 week and reached a plateau of approximately 30 ng. per dl. after 2 months. This was accompanied by a decrease in serum prostatic acid phosphatase from a mean starting concentration of 43 +/- 11 ng. per ml. to a low of 3 +/- 1 ng. per ml. at 12 months; the proportion of normal values increased from 10 to 80 per cent. A complete response was observed in 7 patients (13 per cent), partial response in 35 (69 per cent) and stable disease in 8 (16 per cent), yielding an over-all objective response rate of 98 per cent (1980 National Prostatic Cancer Project criteria). The actuarial median time to progression was 17 months and the median survival time was 23.5 months. In 26 patients who subsequently had signs of progressive carcinoma the relapse rate in bone (85 per cent) far exceeded that in nonskeletal sites (23 per cent). The incidence of cardiovascular toxicity was 12 per cent. These results indicate that cyproterone acetate and low dose diethylstilbestrol may be co-administered to achieve a synergistic and potent androgen withdrawal effect in the treatment of advanced prostatic carcinoma.

Acid Phosphatase↗
PubMed1988

Relative effectiveness of alternative androgen withdrawal therapies in initiating regression of rat prostate.

From a large number of potentially effective androgen withdrawal regimens including bilateral orchiectomy, estrogens, antiandrogens and LHRH agonists alone or in combinations, we compared the ability of 12 different treatment options to mimic the acute results of surgical castration on the rat prostate. Agents were administered s.c. in clinical doses to groups of male rats daily for three days. On day 4 the prostatic tissue was removed and analyzed by conventional methods for whole-tissue and nuclear concentrations of dihydrotestosterone, nuclear androgen receptor and cytoplasmic androgen receptor. Castration-like changes were most pronounced with the synergistic combinations of cyproterone acetate + low-dose diethylstilbestrol, and megestrol acetate + low-dose diethylstilbestrol. Comparing the effectiveness of single agents, low-dose diethylstilbestrol was superior to cyproterone acetate, megestrol acetate, flutamide, leuprolide and RU23908. Leuprolide combined with flutamide was superior to leuprolide + cyproterone acetate, leuprolide + cyproterone acetate + low-dose diethylstilbestrol or leuprolide + RU23908 after three days of administration; however, this advantage disappeared when the treatments were extended to seven days. The observations indicate that the most potent androgen withdrawal therapies such as cyproterone acetate + low-dose diethylstilbestrol and megestrol acetate + low-dose diethylstilbestrol at best approximate but do not surpass the early effects of surgical castration. During the same time course, other regimens are characterized by a slower onset of action and a lesser degree of suppression of androgenic mechanisms within the cell.

Anilides↗
PubMed1988

Relationship of androgen receptors to the growth and regression of the prostate.

Since androgen receptors (AR) stimulate growth and block regression of the prostate through direct binding to nuclear sites, androgen withdrawal therapies must effectively eliminate AR from nuclei to bring about regression of prostatic carcinoma. Using this criterion, we compared the effects of surgical castration with those of 12 different androgen-withdrawal regimens on the rat prostate. The most potent treatment in this regard, a combination of cyproterone acetate and low-dose diethylstilbestrol, caused an initial objective response rate of 98% in 51 patients with stage D prostate cancer. Thus, although assays for AR are useful for evaluating new drugs, the high initial response rates to treatment make them irrelevant for routine patient selection. Accordingly, the principal reason for studying AR is to determine the cellular and molecular processes leading to the eventual emergence of androgen-resistant stem cells. At the cellular level, tumor recurrence in the androgen-dependent Shionogi tumor system is characterized by a 30-fold enrichment of stem cells that possess cytoplasmic AR but that lack the ability to retain AR in the nucleus. While at the molecular level definitive results await the purification of AR and their genes, the occurrence of biologically active truncated and chimeric forms of AR, analogous to those that have been synthesized in vitro for other steroid receptors, would predictably yield an androgen-resistant phenotype.

Androgen Antagonists↗
PubMed1988

Kinetic parameters of 5 alpha-reductase activity in stroma and epithelium of normal, hyperplastic, and carcinomatous human prostates.

To study the influence of 5 alpha-reductase on the concentration of dihydrotestosterone in prostatic tissue, we measured the activity of this enzyme in stroma and epithelium from 15 normal, 50 hyperplastic, and 20 carcinomatous prostates. Maximum velocity (Vmax) and Km parameters based on the Lineweaver-Burk and Eadie-Hofstee transformations of the Michaelis-Menten equation were related to the stromal and epithelial concentrations of dihydrotestosterone. On the basis of relative Vmax values, there was 6-15 times more 5 alpha-reductase activity in stroma than in epithelium regardless of the histology of the prostate. Stromal enzyme activity also was unique in having a 2- to 5-fold larger mean Km value and greater resistance to competitive and noncompetitive inhibition. Despite the enrichment of 5 alpha-reductase activity in stroma, the dihydrotestosterone concentrations in the stromal and epithelial fractions were very similar. In addition, similar concentrations were found in the stromal fractions of hyperplastic and carcinomatous tissues, notwithstanding a 4-fold difference in the mean Vmax values. This anomaly occurred in association with a large disparity in mean Km values, i.e. 68.3 +/- 1.6 (+/- SE) nmol/L in hyperplasia vs. 23.0 +/- 2.9 nmol/L in carcinoma. The dissociation between parameters of 5 alpha-reductase activity and tissue dihydrotestosterone concentrations was apparent to some extent in benign prostatic hyperplasia, in which the lowest stromal androgen concentrations were found in prostates with the largest Vmax and Km values; also, a rise in stromal Km was almost invariably associated with a proportional increase in Vmax (correlation coefficient = 0.95). These data strongly suggest that the stromal and epithelial forms of 5 alpha-reductase are separate isoenzymes, and that the excess of 5 alpha-reductase in stroma does not promote accumulation of an abnormal amount of dihydrotestosterone. They also imply that both the augmentation of 5 alpha-reductase activity in hyperplastic stroma and the condition of benign hyperplasia of the prostate are mutual consequences of a primary increase in Km.

Aged↗
PubMed1985

Female bladder neck reconstruction. Anatomic and physiologic approach.

Postoperative scarring of the bladder neck and urethra after failed anti-incontinence surgery in the female can seriously disrupt the normal mechanisms of bladder storage and emptying. We have analyzed and treated this problem in 10 selected female patients. A "wrap-flap" technique with omental support has been applied to reconstitute the normal anatomy and physiology of the bladder neck. Excellent results were obtained in all patients, with up to fifty-four months of follow-up. We recommend this procedure prior to the implantation of prosthetic material, with its inherent difficulties.

Female↗
PubMed1984

Intraoperative balloon catheter control of renal arteriovenous fistula.

Renal arteriovenous fistulas have been managed with embolic therapy or surgical excision. In the case of a large, hemodynamically significant shunt sudden occlusion of the renal artery may result in profound circulatory decompensation. We managed such a case with a combined approach. An intra-arterial balloon catheter was inserted into the renal artery under fluoroscopic guidance, with constant monitoring of the central cardiac indexes via a Swan-Ganz line. The balloon was inflated and then released as circulatory changes were corrected. Once the patient was stable we performed a simple nephrectomy. We recommend this combined, controlled approach for the management of large arteriovenous fistulas.

Aged↗
PubMed1983

Disseminated intravascular coagulation in carcinoma of prostate: role of estrogen therapy.

Advanced carcinoma of the prostate may present as disseminated intravascular coagulation and its sequelae. It is postulated that the slow release of thromboplastic material from tumor cells eventually overcomes normal homeostatic mechanisms. High-dose intravenous diethylstilbestrol diphosphate successfully reversed this coagulopathy in 2 cases of metastatic carcinoma of the prostate.

Aged↗
PubMed1983

Patch autografts in the treatment of urethral stricture.

Single-stage skin patch urethroplasty has become accepted therapy for urethral stricture. Review of the literature and the authors' experience indicated good short-term clinical results (80%), but the fate of the implanted tissue has not been well documented. Twenty-three skin and vein patch autograft repairs of defects created in the rabbit urethra were examined histologically after 4 weeks in situ. Two of 12 skin grafts remained intact while 9 of 11 vein patches were successful. The vein patch autograft appears to provide better support because of the survival of the elastic and smooth muscle tissues. Unlike skin grafts, which retain their squamous epithelium, the venous endothelium is entirely replaced by urothelium, thus decreasing potential neoplastic degeneration, and the incidence of fistula formation, fibrosis and chronic inflammation. Further investigation is required before introducing the vein patch urethroplasty into clinical practice.

Animals↗
PubMed1982

A critical evaluation of a specific radioimmunoassay for prostatic acid phosphatase.

A radioimmunoassay (RIA) method for acid phosphatase detection was compared to a standard enzyme assay using sera from 210 normal volunteers and 285 patients with prostatic disease. Statistical and clinical comparisons were made between defined subgroups. All 55 normal females had RIA detectable serum acid phosphatase, implying that this assay cannot be entirely specific for enzyme of prostatic origin. Urinary catheterization did not affect acid phosphatase levels. In all stages of carcinoma there were more acid phosphatase elevations by the RIA method than enzyme method, but neither assay could differentiate intracapsular cancer from benign prostatic hyperplasia. A small number of patients with biopsy proven negative nodules had marginally elevated values, suggesting as obligation for closer follow-up. The RIA method may be superior for monitoring patients with more advanced malignancy. Additional practical advantages of the RIA include relative simplicity and elimination of the special serum handling required for the enzyme assay.

Acid Phosphatase↗