Medicine and Health Sciences Commons^™

Nuclear Spindles Pave The Way To Metastasis, Patrick J. Hensley, Natasha Kyprianou

Urology Faculty Publications

No abstract provided.

The Gift That Keeps One Living, Scott R. Axelrod

Capstones

This long-form narrative feature article reports on the shortage of living kidney donors and those in desperate need of kidney transplants. It features interviews with doctors, transplant coordinators, patients, living kidney donors, and kidney recipients. The story culminates with my own personal experience as a kidney donor to my late dad over a decade ago. The presentation includes an extensive photo component capturing characters and elements from the story through a series of detailed portraits, photo essays, and infographics.

https://saxelrod718.wixsite.com/livingkidneydonors

Percutaneous Externally Assembled Laparoscopic (Peal) Donor Nephrectomy: A Cohort Pain Comparison, Tyler Miskin, Isaac Kelly, Matthew Pierce, Samuel Abourbih, Duane D. Baldwin

Loma Linda University Student Journal

Donor nephrectomies can be technically demanding. Donors also may not be fully psychologically prepared for their post-operative pain or cosmetic outcome. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) paradigm was developed to decrease incisional pain and laparoscopic scars. The aim of this study is to compare the post-operative outcomes between donor nephrectomies performed with and without the PEAL instruments.

The Feasibility Of Percutaneous Externally Assembled Laparoscopic Nephrectomy: A New Surgical System, Benjamin West, Jerry Thomas, Mohamed Keheila, Nazih Khater, Samuel Abourbih, Salim Cheriyan, Matthew Pierce, Duane D. Baldwin, Jim Shen

Loma Linda University Student Journal

Laparoendoscopic single-site (LESS) nephrectomy provides excellent cosmetic outcomes, but is technically challenging due to loss of triangulation and increased instrument collision. A novel Percutaneous Externally Assembled Laparoscopic (PEAL) surgical system was developed to simplify minimally invasive surgery while providing a nearly scarless outcome. In this study, the feasibility of the PEAL system for nephrectomy was determined.

Prostate Cancer Microparticles In Men Undergoing Radical Prostatectomy, Malcolm James Dewar

Electronic Thesis and Dissertation Repository

Objectives: To determine changes in prostate microparticle (PMP) concentrations in men with prostate cancer (PCa) after digital rectal examination (DRE), after radical prostatectomy (RP), and at follow-up.

Materials and Methods: 22 men were recruited before RP. Four blood specimens were collected – baseline (specimen 1), post-DRE (specimen 2), immediately post-RP (specimen 3), and follow-up (specimen 4). Pre- and post-DRE urine was collected (Specimen A and B respectively). Flow cytometric analysis of biofluids was performed with fluorescent-labeled antibodies against prostate-specific membrane antigen (PSMA) and polysialic acid. Total MP (TMP) and dual positive (PMP) events per µl of plasma or urine were …

Why American Parents Circumcise Their Sons: An Integrative Review Of Literature, Lacy Lauber

Grace Peterson Nursing Research Colloquium

Background: Since medical evidence supports both pros and cons of routine neonatal male circumcision, expectant and new parents are left to make the decision to circumcise their sons on their own. There is limited research as to why American parents choose to circumcise their newborn sons.

Objectives: The purpose of this integrative literature review is to identify the reasons behind parental decision making in neonatal male circumcision in the United States. Understanding motivating factors in parental decision-making can highlight areas of prenatal education for expectant parents.

Method: An integrative literature review was conducted utilizing these online databases: PubMed, The Cumulative …

Primary Upper Urinary Tract Small Cell Carcinoma: A Case Series And Literature Review, Patrick J. Hensley, Amul A. Bhalodi, Shubham Gupta

Urology Faculty Publications

Background: Primary upper urinary tract small cell carcinoma (SCC) is exceedingly rare with < 30 cases reported in the literature. Little is known about the incidence, diagnosis, treatment, and outcomes in these patients. We present a series of three patients with primary upper tract SCC.

Case Presentation: Patient 1 is an 89-year-old Caucasian male who presented with hydroureteronephrosis and a mass in the proximal right ureter. Biopsy revealed SCC. Without further intervention, the patient died 2 months after his diagnosis. Patient 2 is a 67-year-old Caucasian female who underwent left laparoscopic nephroureterectomy for primary distal ureteral SCC, pT4N1M0. She developed lymphadenopathy and completed external beam radiation to the pelvis and four courses of cisplatin-based chemotherapy. She died from metastatic disease 7 months after diagnosis. Patient 3 is a 45-year-old female who underwent …

Degree Of Twisting And Duration Of Symptoms Are Prognostic Factors Of Testis Salvage During Episodes Of Testicular Torsion, Adam S. Howe, Vinaya Vasudevan, Michael Kongnyuy, Kevin Rychik, Lisa A. Thomas, Maria Matuskova, Steven C. Friedman, Jordan S. Gitlin, Edward F. Reda, Lane S. Palmer

Publications and Research

Background: Testicular torsion is surgical emergency. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. There is scant data regarding the degree of twisting and its association with testis outcomes. The purpose of our study is to explore how the degree of torsion factors into testicular outcome using follow-up data.

Methods: We retrospectively reviewed the records of adolescent males who presented with testicular torsion to our institution, looking at duration of pain symptoms, degree of torsion documented in the …

Mp24- 19- Cost Savings Achieved Through Introduction Of Holep And Care Pathway., James Johannes Md, Andrew Lai, Angelo A. Baccala Md, Joseph Feliciano Md, Clifford Georges Md, Melvin Steinbook Md, Maria Voznesensky Md

Department of Medicine

No abstract provided.

Enterocutaneous Fistulae In Children - A Management Challenge, Ali Imran Amjad, Saqib Hamid Qazi, Zafar Nazir

Zafar Nazir

No abstract provided.

Understanding The Context Of Balanced Scorecard Implementation: A Hospital-Based Case Study In Pakistan., F Rabbani, Sabrina Nh Lalji, Farhat Abbas, Sm Wasim Jafri, Junaid A. Razzak, Naheed Nabi, Firdous Jahan, Agha Ajmal, Max Petzold, Mats Brommels, Goran Tomson

Fauziah Rabbani

Background: As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods: Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs …

Triple Positive Microparticles As A “Liquid Biopsy” For Risk Stratification Of Prostate Cancer, Harmenjit Singh Brar

Electronic Thesis and Dissertation Repository

Prostate cancer remains a substantial contributor to cancer-related mortality worldwide. Current screening methods include obtaining a PSA blood test. However, controversy surrounds its use as it is neither sensitive nor specific.

Nanoscale flow cytometry is a type of microfluidics-based technology that allows enumeration of submicron tumor fragments known as microparticles (MPs). In this study, prostate specific microparticles in patient plasma were targeted using fluorophore-conjugated antibodies. Targeted cell surface antigens or biomarkers include: prostate specific membrane antigen (PSMA), six-transmembrane epithelial antigen of the prostate-1 (STEAP1), ghrelin receptor (GHSR1a) and CD151.

A statistically significant difference in the level of MP levels was …

An Enduring Legacy Of Discovery: Margaret Stirewalt., Lucie Henein, James J Cody, Michael H Hsieh

Urology Faculty Publications

No abstract provided.

Purple Urine Bag Syndrome: An Educational Case Of A Colorful Condition In The Chronically Catheterized, Teshome Gebrmichael, Fikirte Feleke, Waseem Ahmed, Madhulika Urella, Samson Teka

Samson Teka

Purple Urine Bag Syndrome is a rare condition characterized by purple discoloration of the urinary drainage bag. It is typically seen in elderly patients with chronic indwelling urinary catheterization, and is associated with urinary tract infections with high bacterial load, female gender, severe disability, constipation, and alkaline urine. This phenomenon occurs when tryptophan metabolites in the urine are broken down by bacteria containing indoxyl sulphatase and phosphatase enzymes. This results in the production of indigo and indirubin, which combine to give a purple appearance. This article presents a 78-year-old male with chronic urinary retention requiring intermittent Foley catheterization for the …

Reversion Of Epithelial-Mesenchymal Transition By A Novel Agent Dz-50 Via Igf Binding Protein-3 In Prostate Cancer Cells, Zheng Cao, Shahriar Koochekpour, Stephen E. Strup, Natasha Kyprianou

Urology Faculty Publications

Dysregulation of transforming growth factor-β1 (TGF-β1) and insulin-like growth factor (IGF) axis has been linked to reactive stroma dynamics in prostate cancer progression. IGF binding protein-3 (IGFBP3) induction is initiated by stroma remodeling and could represent a potential therapeutic target for prostate cancer. In previous studies a lead quinazoline-based Doxazosin® derivative, DZ-50, impaired prostate tumor growth by targeting proteins involved in focal adhesion, anoikis resistance and epithelial-mesenchymal-transition (EMT). This study demonstrates that DZ-50 increased expression of the epithelial marker E-cadherin, and decreased the mesenchymal marker N-cadherin in human prostate cancer cells. In DU-145 cells, the effect of DZ-50 on EMT …

Purple Urine Bag Syndrome: An Educational Case Of A Colorful Condition In The Chronically Catheterized, Teshome Gebrmichael, Fikirte Feleke, Waseem Ahmed, Madhulika Urella, Samson Teka

Marshall Journal of Medicine

Purple Urine Bag Syndrome is a rare condition characterized by purple discoloration of the urinary drainage bag. It is typically seen in elderly patients with chronic indwelling urinary catheterization, and is associated with urinary tract infections with high bacterial load, female gender, severe disability, constipation, and alkaline urine. This phenomenon occurs when tryptophan metabolites in the urine are broken down by bacteria containing indoxyl sulphatase and phosphatase enzymes. This results in the production of indigo and indirubin, which combine to give a purple appearance. This article presents a 78-year-old male with chronic urinary retention requiring intermittent Foley catheterization for the …

Open Vesicocalicostomy For The Management Of Transplant Ureteral Stricture, Margaret M. Higgins, Jonathan P. Walker, Michael F. Daily, Shubham Gupta

Urology Faculty Publications

A 59-year-old male developed a proximal stricture of his transplant ureter ten years after a living donor renal transplant. Endoscopic management was unsuccessful, and the patient was temporized with percutaneous nephrostomy tubes for months. Eventually, it became clear he would require surgical revision. Intraoperatively, complete fibrosis of the renal hilum, and intrarenal location of the pelvis precluded the planned pyelovesicostomy. A successful open vesicocalicostomy was performed, anastomosing a bladder flap to a lower pole calix. The patient remains recurrence free after 6 months of follow-up.

Interdisciplinary Learning Project, Demetrius H. Bagley, Md, Maryann Sonzogni, Rn, Bsn, Bridget Weissinger, Cst, Kelly A. Healy, Md

Department of Urology Faculty Papers

Description

With a 20 year history, we have implemented a multifaceted IPE program for members of the urology team. These include urologists, both faculty and community, residents, medical students, nurses, nurse practitioners, physician assistants, medical technicians/assistants and administrative/ clerical personnel with patient contact. The program was designed with three components: a yearly symposium for all, and journal club(JC) and lectures for non-physicians. Participation is on a voluntary, noncompensatory basis. Outcome measures include routine anonymous participant feedback via questionnaire.

Results

The programs were very positively received. Limiting obstacles were also observed. Initially too many papers were assigned in the Journal club. …

Stages Of Chronic Kidney Disease And Soluble Transferrin Receptor (Stfr), Ferritin, Ratio, Faiza Alam Faiza Alam, Syeda Sadia Fatima, Sabeela Noor Sabeela Noor, Ahmed Bilal, Rehana Rehman

Department of Biological & Biomedical Sciences

Objective: To assess the ratio of soluble transferrin receptor to ferritin in different stages of chronic kidney disease.
Methods: This case-control study was conducted at the Aga Khan University Hospital and the Jinnah Postgraduate Medical Centre, Karachi, from January to September 2014, and comprised chronic kidney disease patients and healthy controls. Group 1 comprised controls, whereas groups 2, 3 and 4 had patients based on their mean glomerular filtration rate. SPSS 19 was used for data analysis.
Results: Of the 170 participants, 126(74.1%) were cases and 44(25.9%) were controls. The overall mean age was 55.87±3.48 years and the mean body …

Disulfide High Mobility Group Box-1 Causes Bladder Pain Through Bladder Toll-Like Receptor 4, Fei Ma, Dimitrios E. Kouzoukas, Katherine L. Meyer-Siegler, Karin N. Westlund, David E. Hunt, Pedro L. Vera

Physiology Faculty Publications

Background: Bladder pain is a prominent symptom in several urological conditions (e.g. infection, painful bladder syndrome/interstitial cystitis, cancer). Understanding the mechanism of bladder pain is important, particularly when the pain is not accompanied by bladder pathology. Stimulation of protease activated receptor 4 (PAR4) in the urothelium results in bladder pain through release of urothelial high mobility group box-1 (HMGB1). HGMB1 has two functionally active redox states (disulfide and all-thiol) and it is not known which form elicits bladder pain. Therefore, we investigated whether intravesical administration of specific HMGB1 redox forms caused abdominal mechanical hypersensitivity, micturition changes, and bladder inflammation in …

Structure Activity Relationship Studies Of Novel Diarylpentanoid Analogs Targeting The Androgen Receptor In Prostate Cancer Cells, Haili Coffin, Marco Bisoffi

Student Scholar Symposium Abstracts and Posters

The development of prostate cancer (PCa) relies strongly on the activation of the androgen receptor (AR) signaling pathway by its natural ligand dihydrotestosterone. Furthermore, PCa progression to metastatic disease represents oncogene addiction to AR activity. Androgen ablation therapy is thus a mainstay therapy against this disease, but the development of ligand-independent AR activation and persisting AR expression eventually leads to castration resistant PCa (CRPC). Therefore, down-regulation of AR expression in PCa cells may be an effective therapeutic modality. The diarylpentanoid ca27 has previously been shown to down-regulate AR expression by an unknown mechanism of action. The present work represents a …

Hyper Ige Syndrome And Renal Cell Carcinoma, N Patel, Mark J. Ferretti, John L. Phillips

NYMC Faculty Publications

Hyper IgE Syndrome (HIES) is an immunodeficiency disorder characterized by increased serum levels of IgE, eczema, and recurrent cutaneous and pulmonary infections. In this report, we present, to our knowledge, the first documented case of renal cell carcinoma (RCC) found in a patient with HIES. The patient received infectious disease clearance prior to obtaining a partial nephrectomy which revealed clear cell histology. Both HIES and RCC have an immunological basis for their pathophysiology and may involve common pathways. Further studies may provide insight into any possible link and clinicians should be mindful of immunocompromised patients who present with risk factors …

Effect Of Duration Of Symptoms On Orchiectomy Rates In Testicular Torsion In Patients Under 25: Important Prognostic Trends, Lior Taich, Marc Zeffren, Muhammad Choudhury

NYMC Student Posters

The purpose of this study is to explore the relationship between duration of symptoms in testicular torsion and the effect on orchiectomy rates, with the intention of establishing an updated timeline for clinical management and surgical urgency.

Urologists’ Views On Contact With Industry Representatives: A Pilot Survey, Marc Zeffren, Joel Hillelsohn, Michael Stern

NYMC Student Posters

Purpose: The current survey aims to determine the various ways in which urologists at all levels of training view the nature of their relationships with industry representatives, and the effects these relationships may have on clinical practice and behavior. Methods: We sent an anonymous SurveyMonkey® questionnaire to a cohort of approximately 1700 practicing urologists in various urologic subspecialties across the country. The questionnaire elicited information related to demographics, personal awareness of institutional guidelines regarding PR/DMR, and opinions regarding the following: •the ability of industry-supplied gifts to compromise judgment •the utility and appropriateness of industry representatives in the clinical setting •the …

Impact Of Smartphone Digital Photography, Email, And Media Communication On Emergency Room Visits Post-Hypospadias Repair., Michael E. Chua, Megan A. Saunders, Paul R. Bowlin, Jessica M. Ming, Roberto Iglesias Lopes, Walid A. Farhat, Joana Dos Santos

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates.

METHODS: This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for …

Mechanisms Of Therapeutic Resistance In Prostate Cancer, Mary Nakazawa, Channing Paller, Natasha Kyprianou

Urology Faculty Publications

Prostate cancer is the second leading cause of cancer deaths in the USA. The challenge in managing castration-resistant prostate cancer (CRPC) stems not from the lack of therapeutic options but from the limited duration of clinical and survival benefit offered by treatments in this setting due to primary and acquired resistance. The remarkable molecular heterogeneity and tumor adaptability in advanced prostate cancer necessitate optimization of such treatment strategies. While the future of CRPC management will involve newer targeted therapies in deliberately biomarker-selected patients, interventions using current approaches may exhibit improved clinical benefit if employed in the context of optimal sequencing …

Autologous Mesenchymal Stem Cell Transplantation In Male Stress Urinary Incontinence, Benjamin Mann, Keerat Kaur, John Phillips, Carol Eisenberg, Leonard M. Eisenberg

NYMC Faculty Posters

No abstract provided.

Metastatic Melanoma To The Bladder: Case Report And Review Of The Literature., Rohit V. Patil, Solomon L Woldu, Elena Lucas, Andrew M Quinn, Franto Francis, Vitaly Margulis

Urology Faculty Publications

A 49-year-old Caucasian woman presented to the dermatology clinic for follow-up of malignant melanoma with a complaint of painless gross hematuria. Two years prior she was diagnosed with malignant melanoma from a skin lesion on her left flank treated with wide excision, negative axillary sentinel lymph node biopsy, and adjuvant radiotherapy. Subsequently, she had no evidence of disease until urologic evaluation of her hematuria revealed two lesions in her bladder and cytopathology demonstrated findings consistent with malignant melanoma. We review literature on melanoma metastatic to the bladder and discuss the potential role of metastasectomy and other treatment strategies in such …

Dysuria: An Uncommon Presentation In Emergency Department Following Bladder Neck Disruption., Ali Pourmand, Assya Abdallah, Hamid Shokoohi, Mindy Park, Marie White, Francis O'Connell

Emergency Medicine Faculty Publications

Prostate cancer is the most common life-threatening cancer diagnosed in men. Complications of prostatectomies vary and often include urinary incontinence, erectile dysfunction and pain, while other complications go unreported. While emergency physicians are already familiar with the more common post-operative complications presenting to their departments, including urinary retention, ileus, surgical site infections, venous thromboembolisms and urinary tract infections, they must have a high index of suspicion for rarer complications. We report a case of posterior bladder neck disruption as a complication of a robotic assisted laparoscopic prostatectomy that presented to the emergency department as dysuria and abdominal pain following urination.

Press-Pulse: A Novel Therapeutic Strategy For The Metabolic Management Of Cancer, Thomas Seyfried, George Yu, Joseph Maroon, Dominic D'Agostino

Urology Faculty Publications

Background

A shift from respiration to fermentation is a common metabolic hallmark of cancer cells. As a result, glucose and glutamine become the prime fuels for driving the dysregulated growth of tumors. The simultaneous occurrence of “Press-Pulse” disturbances was considered the mechanism responsible for reduction of organic populations during prior evolutionary epochs. Press disturbances produce chronic stress, while pulse disturbances produce acute stress on populations. It was only when both disturbances coincide that population reduction occurred.

Methods

This general concept can be applied to the management of cancer by creating chronic metabolic stresses on tumor cell energy metabolism (press disturbance) …