Search PubMed⌕ Search

Biomedical subjects

S Raz

Publications and source records attributed to S Raz.

At least 55 records · Page 3Linked to original sources
PubMed1994

Physiological changes induced in cardiac myocytes by cytotoxic lymphocytes: an autoimmune model.

BACKGROUND: cytotoxic lymphocytes are important in the pathogenesis of several disease states, yet, the pathophysiology of lymphocyte-myocyte interaction is not well known. METHODS AND RESULTS: We have developed a model for the in vitro evaluation of autoimmune cytotoxic myocardial damage. Cardiac myocytes were repeatedly injected to adult autologous rats. Following 3 months, histological evidence of myocarditis was seen in 20% of the hearts. Cultured myocytes obtained from newborn rats were exposed to lymphocytes isolated from the immunized animals. Cytotoxic activity was measured using crystal violet staining test. The percentage of killing was increased as the ratio of lymphocytes/myocytes was increased. Verapamil did not block this cytotoxic effect. No killing was seen when myocytes were exposed to non-sensitized lymphocytes. Physiological changes induced in myocytes by cytotoxic lymphocytes were studied. Cell wall motion was measured by an optical method and action potentials with intracellular microelectrodes. Physiological changes observed in myocytes following exposure to cytotoxic lymphocytes included: Impaired relaxation with prolonged contractions, oscillations and prolongation of the plateau of the action potential. Cellular contraction was prolonged up to 4 s before total arrest of spontaneous activity. Verapamil but not tetrodotoxin restored action potentials and contractions to normal. Supernatant collected from cultures of myocytes and lymphocytes had the same effect on myocytes contractility as observed following exposure of myocytes to cytotoxic lymphocytes. CONCLUSIONS: This supports our hypothesis that these physiological alterations observed in myocytes are mediated by a soluble factor secreted by cytotoxic lymphocytes.

Action Potentials↗
PubMed1994

Obstruction following anti-incontinence procedures: diagnosis and treatment with transvaginal urethrolysis.

We reviewed the charts of 41 patients who underwent transvaginal urethrolysis and resuspension of the bladder neck by the Raz technique for urethral obstruction with or without stress urinary incontinence following anti-incontinence surgery. We sought to evaluate the effectiveness of the procedure as well as to determine any factors that had an effect on the outcome of surgery. Patients were evaluated for obstruction and stress urinary incontinence by history, physical examination, video urodynamics (or multichannel urodynamics plus cystogram and voiding cystourethrography) and cystoscopy. All patients reported normal emptying before the procedure that caused obstruction. Several variables were evaluated for individual predictive values for outcome, including type of surgery causing obstruction, number of previous anti-incontinence procedures, urodynamic evidence of obstruction (high pressure, low flow), instability, concomitant stress urinary incontinence and total urinary retention, which were evaluated by the Fisher exact test, and the amount of post-void residual, bladder capacity, maximum detrusor pressure, maximum urinary flow and interval since surgery causing obstruction, which were evaluated by logistic regression analysis. Mean patient age was 59 years (range 26 to 86 years) and mean followup was 21 months. A total of 19 patients (46%) suffered from concurrent stress urinary incontinence, 23 (56%) had urodynamic evidence of obstruction (high pressure/low flow) and 6 (15%) had only radiographic or endoscopic evidence with a deviated or kinked urethra. Postoperatively, 29 patients (71%) voided normally without significant residuals. Eight patients (20%) remain on self-catheterization and 1 has persistent stress urinary incontinence. When individual variables were evaluated to determine the predictive values with respect to outcome of urethrolysis, only the preoperative post-void residual was statistically significant (the greater the post-void residual, the more likely was failure, p = 0.021). The presence or strength of the detrusor contraction preoperatively and pressure-flow analysis did not predict outcome. Of the patients with stress urinary incontinence 15 (79%) were cured and 3 (16%) were significantly improved with rare stress urinary incontinence not requiring protection. Overall, 33 patients (80%) had some benefit from surgery. Patients who emptied normally before and anti-incontinence procedure that causes obstruction or impaired emptying should not be excluded from urethrolysis based on low detrusor pressures or pressure-flow analysis alone. Simultaneous radiographic imaging and endoscopy may help to select certain patients with obstruction.

Female↗
PubMed1994

Gross brain morphology in schizophrenia: a regional analysis of traditional diagnostic subtypes.

Fifty-six patients with chronic schizophrenia were categorized into 2 groups based on traditional diagnostic subtypology. They were then compared on indices of cortical and subcortical cerebrospinal fluid (CSF) volume to explore whether the more virulent nonparanoid disorder was linked to cortical or subcortical morphological brain abnormalities. They were examined also to determine whether abnormalities in a specific cerebral region were related to greater chronicity or severity of schizophrenia. The two groups differed significantly only in subcortical but not cortical CSF volume. The regional changes, however, did not appear to characterize exclusively the virulent subtypes. The results and their implications for future studies on the neuroanatomical correlates of schizophrenia subtypes are discussed.

Adolescent↗
PubMed1994

Genitourinary problems in the elderly patient.

Dramatic advances across several fronts have provided a marked improvement in the quality of life for the elderly urologic patient. Radical surgery for cancer is much safer than in the past, and our focus is on preservation of function or complete functional reconstruction. In other areas we strive to continue to deliver excellent treatment while minimizing patient morbidity. This is seen most dramatically in the treatment of urinary stone disease. Ongoing work in patients with BPH promises to provide similar benefits to this population in the coming years. At the same time, we must remember that our abundance of therapeutic options imposes a responsibility to individualize treatment so as to best serve each patient.

Aged↗
PubMed1993

Clear cell odontogenic carcinoma with lymph node metastasis.

Clear cell odontogenic tumors are rare. Review of the literature showed 9 cases with a prominent clear cell component. These lesions have exhibited an aggressive behavior characterized by an infiltrative local growth pattern, recurrence, or metastases. We report a case of an odontogenic tumor that exhibited a biphasic pattern and was characterized by lymph node involvement identical histologically to the primary tumor. We conclude that the presence of a clear cell component in an ameloblastomatous tumor should be viewed as a sign of de-differentiation, and that a malignancy with or without metastases should be considered and ruled out in such cases.

Adenocarcinoma↗
PubMed1993

Ectopic ureter presenting in midline urethral diverticulum.

A rare case of an ectopic ureter terminating in a urethral diverticulum is presented. While numerous cases of extravesical ectopic ureters draining directly into the urethra or uterovaginal canal have been reported, the termination of a ureter as a diverticular sac is extremely unusual. Moreover, only rarely has a urethral diverticulum been documented to arise congenitally due to any cause. The history and management of this new case are detailed, and the general subjects of ectopic ureter and urethral diverticulum are discussed with particular reference to etiology and continence.

Adult↗
PubMed1993

Ischemia of neobladder. Clinical manifestations and management.

Substitution enterocystoplasty is becoming more common in a selected group of patients. Acute or chronic ischemia is an exceptional event. We describe the clinical manifestations and management of chronic ischemia of a neobladder that occurred weeks after a successful initial operation. The possible mechanisms responsible for this complication are reviewed.

Chronic Disease↗
PubMed1993

Transvaginal repair of vesicovaginal fistula using a peritoneal flap.

Even complex vesicovaginal fistulas may be repaired transvaginally. In difficult repairs adjunctive measures have been described to increase the success rate of surgery, including Martius flaps, labial flaps or gracilis muscle flap. We describe a new technique to repair difficult vesicovaginal fistulas via a transvaginal approach. A flap of peritoneum is developed and used to buttress the fistula repair. This repair was successful in 9 of 11 patients (82%). Complications occurred in only 1 patient who suffered a bladder diverticulum containing a stone. The major advantage of this technique is its simplicity and lack of an extravaginal harvesting incision. This repair is particularly well suited for complex, high lying vesicovaginal fistulas.

Adult↗
PubMed1993

Gastrocystoplasty without opening the stomach.

We describe a modification of gastrocystoplasty using the GIA stapler to harvest the segment for augmentation without opening the stomach. This simplification reduces operative time and blood loss without introducing complication specific to it and has been successfully used in our first 5 patients.

Adolescent↗
PubMed1993

Transvaginal repair of enterocele.

The urologist actively involved in the treatment of female genitourinary disease must to be able to recognize and treat various forms of pelvic prolapse. Enterocele is commonly seen in conjunction with stress urinary incontinence and cystocele or it may result from surgery to correct these problems. Many techniques to correct enterocele have been developed, including transvaginal repairs as well as intra-abdominal procedures such as the Moschcowitz technique or colpofixation to the sacrum for enterocele with vault prolapse. Surgical management of enterocele must take into account several factors, including the presence of stress urinary incontinence, rectocele, vaginal vault prolapse, prior hysterectomy and the desire to maintain sexual activity. Based on these considerations we discuss our approach to the transvaginal repair of enterocele. In patients without vault prolapse a simple enterocele repair is performed. If vault prolapse is present, then the condition of the anterior vaginal wall is considered. In patients with a cystocele a vault suspension procedure is performed, which involves simultaneous suspension of the uterosacral-cardinal ligament complex and vaginal vault along with the bladder neck and bladder. There are 2 modifications of this technique depending on the degree of cystocele: the 4-corner vault suspension for grades 2 and 3 cystocele, and the vault suspension with grade 4 cystocele repair. Patients with vault prolapse and no cystocele undergo sacrospinous ligament fixation. In elderly patients who are not sexually active, especially if they are in poor medical condition, partial colpocleisis is considered. In these patients partial colpocleisis was not performed as a primary procedure but it was done later in 3 who failed an initial attempt at repair. All coexisting vaginal pathology is fixed at the time of enterocele repair. A total of 83 patients underwent enterocele repair according to this protocol and 81 were available for followup. Mean followup was 15 months (range 3 to 70). Overall a successful result (no recurrence) was achieved in 70 patients (86%). Success for individual procedures was 40 of 49 (82%) for simple repair, 24 of 25 (96%) for vault suspension and 6 of 7 (86%) for sacrospinous fixation. In all cases vault suspension or sacrospinous fixation was able to restore vaginal depth and axis with minimal or no vaginal shortening.

Aged↗
PubMed1993

The Raz bladder neck suspension in patients 65 years old and older.

We reviewed the charts of 92 women 65 years old and older (mean age 72 years, range 65 to 87 years) who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 17 months. Overall, a successful outcome (cure or rare stress urinary incontinence not requiring protection) was achieved in 81 patients (88%). The 2-sample Wilcoxon rank sum test showed that the only predictor of outcome was the subjective degree of preoperative stress urinary incontinence (mild, moderate or severe, p = 0.0148). When the results were stratified by degree of incontinence preoperatively 8 of 8 patients (100%) with mild, 62 of 67 (93%) with moderate and 11 of 17 (65%) with severe incontinence had a successful outcome. Prior hysterectomy, number and type of previous anti-incontinence procedures, and the presence of urgency, urgency incontinence or urodynamic instability were not statistically significant predictors of outcome. In addition, the degree of clinical instability preoperatively had no correlation with the degree of postoperative instability. Of 11 failures 10 occurred within 1 year postoperatively. Significant urgency incontinence was present preoperatively in 32% of the patients with postoperative resolution in 60%. De novo urgency and urgency incontinence occurred in 24% and 13% of the patients, respectively. There was no statistically significant difference in the outcome of surgery in patients 65 years old and older compared to 141 patients less than 65 years old with respect to success, cure of stress urinary incontinence, cure of significant urgency and urgency incontinence, and appearance of de novo instability. The Raz bladder neck suspension is a safe and efficacious treatment for stress incontinence in elderly women. Outcomes can be expected to be the same as in younger women.

Age Factors↗
PubMed1993

Structural cerebral pathology in schizophrenia: regional or diffuse?

Is brain pathology in schizophrenia topographically distinct? If so, are the putative regional changes unique to the disorder? To address these questions, 56 chronic schizophrenic Ss were compared with 16 psychiatric control Ss with mood disorders and with 31 healthy volunteers on multiple-volume measures of regional cerebral atrophy obtained with computed tomography. Generalized cortical and subcortical enlargement of spaces filled with cerebrospinal fluid sparing only the occipitoparietal cortex was found in the schizophrenic Ss compared with normal control Ss. Statistically significant differences in the extent of perisylvian atrophy were noted between schizophrenic Ss and patients with mood disorders: Schizophrenic Ss evidenced greater dilation of perisylvian fissures and sulci. The implications of the results for future research and for recent theories on the etiology of schizophrenia are discussed.

Adolescent↗
PubMed1992

Vaginal wall sling: four years later.

Since December 1985, we have treated 65 patients with urinary stress incontinence due to intrinsic sphincter dysfunction with the vaginal wall sling procedure. Of the 54 patients who were available for follow-up, intrinsic sphincter dysfunction was related to multiple prior bladder neck suspension procedures in 48 patients. In the remaining 6 patients, 2 had pelvic trauma, 2 had neurogenic urethral dysfunction, 1 had urethral diverticulectomy, and 1 had pelvic radiation. The success rate of the vaginal wall sling procedure for correcting stress incontinence was 94.4 percent at a mean follow-up of 23.9 months. Postoperative complications were minimal. Although 83 percent were temporarily in urinary retention, in the absence of neurogenic bladder and augmentation cystoplasty, only 5.5 percent needed intermittent self-catheterization on a long-term basis. De novo detrusor instability developed postoperatively in 14.8 percent of the cases. In no patient did a vaginal inclusion cyst develop. The vaginal wall sling is a simple procedure with excellent success rate and minimal morbidity. We recommend it for patients with stress urinary incontinence due to intrinsic sphincter dysfunction.

Adult↗
PubMed1992

The Raz bladder neck suspension: results in 206 patients.

We reviewed the charts of 206 patients who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 15 months. Overall, our results demonstrated a successful outcome (cure or rare stress urinary incontinence not requiring protection) in 186 of 206 patients (90.3%). Cox multivariant analysis showed that the only predictor of outcome was the degree of preoperative stress urinary incontinence (mild, moderate or severe, p less than 0.001). When the results were stratified by degree of incontinence preoperatively 20 of 21 patients (95%) with mild, 151 of 162 (93%) with moderate and 15 of 23 (65%) with severe incontinence had a successful outcome. No statistical correlation was found with patient age, number of prior operations, hysterectomy, urgency incontinence or menopause. For the patients who failed, the mean interval to recurrent stress urinary incontinence was 5 months. Significant urgency incontinence was present preoperatively in 58 of the 204 patients (29%), with postoperative resolution in 66%. De novo urgency incontinence occurred in 7.5%. Complications included secondary prolapse (6% of the patients), prolonged retention (2.5%) and suprapubic pain (3%). In summary, the Raz bladder neck suspension for correction of stress urinary incontinence has been successful in more than 90% of this patient population.

Adolescent↗
PubMed1992

Levator hernia.

We report a case of a hernia through the pelvic floor presenting as a paravaginal mass following a transvaginal fascial sling procedure. At exploration herniation through a defect in the pelvic floor was identified and repaired. To our knowledge this is the first reported case of levator hernia. The clinical and radiological findings and anatomy are presented, and treatment recommendations and etiology are discussed.

Aged↗