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Journal of Andrology 1991Although the exact cause of benign prostatic hyperplasia (BPH) is not well defined, it is thought to occur as the result of epithelial-stromal interactions in the... (Review)
Review
Although the exact cause of benign prostatic hyperplasia (BPH) is not well defined, it is thought to occur as the result of epithelial-stromal interactions in the appropriate hormonal milieu. Benign prostatic hyperplasia originates in the periurethral and transition zones of the prostate in a microscopic (histologically identifiable) state as early as the third decade of life. With advancing age and the presence of androgens, approximately 50% of microscopic BPH will develop into macroscopic (palpably enlarged prostate) BPH. However, clinically significant BPH necessitating treatment will develop in only 50% of men with an enlarged prostate gland. In the United States, the estimated risk of a 50-year-old man undergoing a prostatectomy in his lifetime is approximately 25% to 40%. If left untreated, a significant number of symptomatic patients will remain stable or improve without adverse sequelae.
Topics: Adult; Aged; Aged, 80 and over; Aging; Humans; Male; Middle Aged; Prostatic Hyperplasia
PubMed: 1722790
DOI: No ID Found -
AJR. American Journal of Roentgenology Feb 1999Our goal was to determine the frequency with which mammography reveals nonpalpable malignancies in women with benign palpable masses and to compare these nonpalpable...
OBJECTIVE
Our goal was to determine the frequency with which mammography reveals nonpalpable malignancies in women with benign palpable masses and to compare these nonpalpable malignancies with the palpable malignancies and nonpalpable malignancies detected in asymptomatic women.
SUBJECTS AND METHODS
This study of nominally asymptomatic women involved 85,399 consecutive mammographic examinations, of which 3459 (4.1%) examinations were performed on women who had palpable masses identified before or at the time of mammography. A medical outcomes audit identified mammographic examinations after which breast cancer was diagnosed and determined selected surrogate measures for mortality reduction for the mammographically detected malignancies.
RESULTS
Of the 3459 examinations in women with palpable masses, 64 cases of cancer were revealed by mammography. Of these, 54 cases involved palpable malignancies (15.6/1000 examinations) and 10 involved nonpalpable malignancies (2.6/1000 examinations). Of the 81,940 examinations in asymptomatic women, 346 cases of nonpalpable cancer were detected (4.2/1000 examinations). Of the 10 cases of nonpalpable cancer detected in women with benign palpable masses, median tumor size was 13.8 mm, 10% had axillary node metastasis, and 10% were stage 2 or higher. The corresponding surrogate measures for cases of nonpalpable cancer detected in asymptomatic women were median tumor size, 13.6 mm; node metastasis, 7%; stage 2 or higher, 14%. The surrogate measures for the 54 palpable malignancies were median tumor size, 23.7 mm; node metastasis, 31%; stage 2 or higher, 63%.
CONCLUSION
The surrogate measures for the nonpalpable malignancies in women with benign palpable lesions resemble those in asymptomatic women and are much more favorable than those of palpable malignancies. Therefore, in women with a palpable breast mass, it is important to use mammography to screen the remainder of both breasts for nonpalpable cancer.
Topics: Adult; Breast Neoplasms; Breast Self-Examination; Female; Humans; Lymphatic Metastasis; Mammography; Mass Screening; Medical Audit; Middle Aged; Palpation
PubMed: 9930773
DOI: 10.2214/ajr.172.2.9930773 -
Obstetrics and Gynecology Mar 2006The objective of this review is to summarize the published data about squamous carcinoma of the vulva and to identify promising areas for future investigation. Rather... (Review)
Review
The objective of this review is to summarize the published data about squamous carcinoma of the vulva and to identify promising areas for future investigation. Rather than the routine use of complete radical vulvectomy, a radical wide excision of the vulvar lesion to achieve at least a 1-cm gross margin appears sufficient to treat the primary lesion. A surgical assessment of the groin is required for all patients who have invasion greater than 1 mm. Ipsilateral groin node dissection can be performed through a separate incision. All the nodal tissue medial to the vessels and above the fascia should be removed. Sentinel node evaluation may be a significant step forward, but the false-negative rate is not well enough defined to consider this a standard. Patients with positive inguinal nodes at groin dissection should receive radiation therapy to the ipsilateral groin and hemipelvis. For those patients who have unresectable primary disease or if nodes are palpably suspicious, fixed, and/or ulcerated preoperatively, chemoradiation is the preferred option. Exenterative procedures may rarely be required. Chemotherapy for recurrent or metastatic disease has not been proven to be of value. Although survival rates are high for those with negative nodes, the morbidity associated with standard radical techniques has prompted innovation. Adequately powered trials aimed at further reducing morbidity without compromising survival are underway.
Topics: Carcinoma, Squamous Cell; Female; Humans; Lymphatic Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Postoperative Complications; Prognosis; Quality of Life; Vulvar Neoplasms
PubMed: 16507947
DOI: 10.1097/01.AOG.0000202404.55215.72 -
The American Journal of Case Reports Apr 2024BACKGROUND Endometriosis is a common cause of chronic pelvic pain among women globally. Pharmacological therapy for endometriosis includes non-steroidal...
BACKGROUND Endometriosis is a common cause of chronic pelvic pain among women globally. Pharmacological therapy for endometriosis includes non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives, while surgical therapy often involves either laparoscopic excision and ablation of endometriosis implants or open surgery. Surgical therapy is one of the mainstays of treatment especially for extrapelvic endometriomas. However, little guidance exists for the treatment of non-palpable or intermittently palpable lesions of this nature. CASE REPORT A 33-year-old woman with a previous cesarean section presented with complaints of intermittent discomfort in the area between her umbilicus and the surgical incision, for the previous 7 years, that worsened during her menstrual cycle. A 3×3-cm area of fullness was only intermittently palpable during various clinic visits, but was visualizable on computed tomography and magnetic resonance imaging. Given the lesion's varying palpability, a Savi Scout radar localization device was placed into the lesion pre-operatively to aid with surgical resection. The mass was excised, pathologic examination revealed endometrial tissue, and the patient had an uncomplicated postoperative course with resolution of her symptoms. CONCLUSIONS Surgical removal of extrapelvic endometrioma lesions can be made difficult by varying levels of palpability or localizability due to a patient's menstrual cycle. The Savi Scout, most commonly used in breast mass localization, is a useful tool in guiding surgical excision of non-palpable or intermittently palpable extrapelvic endometrioma lesions.
Topics: Pregnancy; Female; Humans; Adult; Endometriosis; Cesarean Section; Breast; Laparoscopy; Pelvic Pain
PubMed: 38581119
DOI: 10.12659/AJCR.942581 -
Journal of Electromyography and... Oct 2012Decreasing an elevated muscle tone is an often cited benefit of spinal manipulation. Spinal manipulation is theorized to disrupt an assumed pain-spasm-pain cycle that... (Review)
Review
Decreasing an elevated muscle tone is an often cited benefit of spinal manipulation. Spinal manipulation is theorized to disrupt an assumed pain-spasm-pain cycle that sufferers of low back pain may be experiencing. The current research has mostly investigated the short term influence of a single spinal manipulation on paraspinal muscle activity either at rest (e.g. standing or prone) or during simple movements (e.g. forward bend). The higher quality experiments to date have typically reported both reductions in muscle activity during lying prone or during the fully flexed position of forward bend. The only study measuring the long term influence of spinal manipulation has failed to document any change in muscle activity as measured with surface electromyography. Both manually delivered manipulations and manipulations delivered via a mechanical adjusting device have been associated with changes in muscle activation. Changes in muscle activity at muscles distant from the spinal joints manipulated (e.g. muscles in the upper limbs) have been documented following a single spinal manipulation however rather than the typical reduction in muscle activity an increase in resting activation has been reported. The state of muscle dysfunction (e.g. palpably tender or subjectively taut) may be a factor in achieving a myoelectric response to spinal manipulation. Currently, the clinical significance of short term changes in electromyographic amplitude following manipulation is unknown.
Topics: Back; Electromyography; Humans; Kinesiology, Applied; Manipulation, Spinal; Muscle Contraction; Muscle, Skeletal; Spine; Treatment Outcome
PubMed: 22425147
DOI: 10.1016/j.jelekin.2012.02.010 -
Archives of Family Medicine Nov 1992Benign prostatic hyperplasia is a nonmalignant enlargement of the prostate that is due to both epithelial and stromal hyperplasia. Although the exact origin of this... (Review)
Review
Benign prostatic hyperplasia is a nonmalignant enlargement of the prostate that is due to both epithelial and stromal hyperplasia. Although the exact origin of this condition is not well defined, it is thought to arise as microscopic nodules in the periurethral tissue of the prostate gland as early as the late '20s. With advancing age and the presence of androgens, this histologically identifiable hyperplastic tissue progresses to a macroscopic state, which is a palpably enlarged prostate. This enlarged prostate causes clinically significant obstruction of the bladder outlet in many men, necessitating therapeutic intervention. Currently, prostatectomy is the standard treatment with successful long-term results. Nevertheless, much information has become available recently on its indications, outcomes, associated morbidity and mortality, and effect on quality of life. Because of these findings as well as the rising healthcare costs and the desire among patients to avoid surgery if possible, there is much enthusiasm for developing less expensive, less invasive, but effective treatments for symptomatic benign prostatic hyperplasia. To appreciate the tremendous advances being made with regard to the treatment of benign prostatic hyperplasia, it is necessary to have a complete understanding of the disease process itself and its traditional therapies. This clinical report provides a comprehensive review of the natural history, epidemiologic characteristics, and outcomes of both open and transurethral surgery for benign prostatic hyperplasia.
Topics: Age Distribution; Humans; Male; Prostatectomy; Prostatic Hyperplasia; Risk Factors
PubMed: 1285243
DOI: 10.1001/archfami.1.2.257 -
Urology Jul 2003To determine the effectiveness of immediate surgical exploration in salvaging perinatal testicular torsion. (Review)
Review
OBJECTIVES
To determine the effectiveness of immediate surgical exploration in salvaging perinatal testicular torsion.
METHODS
A retrospective analysis from 1995 to 2000 of boys younger than 30 days of age with surgically documented extravaginal testicular torsion was conducted. All cases were diagnosed after a normal testicular examination by a neonatologist, and all patients underwent urgent exploration to confirm the exact diagnosis and attempt testicular salvage by detorsion with bilateral orchiopexy. If a nonviable testis was determined intraoperatively, it was removed and contralateral orchiopexy was performed. Success was determined by physical examination at 6 months of follow-up.
RESULTS
Ten patients with 10 affected testes were identified and a total of 4 (40%) were salvaged. All the studied testes were right-sided, and of the 4 salvaged testes, all were palpably normal and equal in size to their mate at the 6-month follow-up examination. Of the 6 removed testes, 1 was potentially viable by permanent pathologic section analysis despite preoperative ultrasonography demonstrating no flow and a negative intraoperative bleed test.
CONCLUSIONS
Boys younger than 30 days old presenting with clinical findings suggestive of extravaginal testicular torsion who are expeditiously explored surgically may have a salvageable event in at least 40% to 50%. These statistics are similar to the salvage rates found with the similar management approach of intravaginal torsion.
Topics: Emergencies; Humans; Infant, Newborn; Male; Orchiectomy; Retrospective Studies; Spermatic Cord Torsion; Testis; Treatment Outcome; Ultrasonography
PubMed: 12837441
DOI: 10.1016/s0090-4295(03)00402-3 -
Annals of Plastic Surgery Oct 2019For thin women with little subcutaneous fat and micromastia, they could not obtain ideal results by choosing autologous fat breast augmentation or prosthesis-only breast...
OBJECTIVE
For thin women with little subcutaneous fat and micromastia, they could not obtain ideal results by choosing autologous fat breast augmentation or prosthesis-only breast augmentation. To address these problems, we combined autologous fat and prosthesis for breast augmentation, and the clinical results were satisfactory.
METHODS
Eleven cases of composite breast augmentation from 2014 to 2017 were analyzed retrospectively. Postoperative follow-up and evaluation were completed. The operations were performed through a subaxillary incision, and the round, high-convex breast prostheses were implanted into the retropectoralis major space. Autologous fat was injected into subcutaneous, retromammary, and prepectoralis layers to cover the whole breast before and after implanting the prosthesis.
RESULTS
The mean follow-up period was 16 months (range, 6-36 months). All patients were satisfied with the size of their breasts. Postoperative complications such as infection, vascular embolism, delayed healing incision, hematoma, and seroma were not detected. In 1 case, the sensation of a unilateral nipple-areola was decreased initially but recovered after 4 months. Long-term complications such as capsular contracture, palpable nodules, double-bubble deformity, asymmetry, poor handling, implant edge visibility, and palpability also did not occur.
CONCLUSION
Breast augmentation combining autologous fat and prosthesis was safe and could achieve aesthetically satisfactory results.
Topics: Adipose Tissue; Adult; Breast Implants; China; Esthetics; Female; Humans; Mammaplasty; Middle Aged; Patient Satisfaction; Retrospective Studies; Transplantation, Autologous
PubMed: 31513060
DOI: 10.1097/SAP.0000000000002093 -
The Breast Journal Aug 2021Intraoperative nodal palpation in the axilla is a mandatory part of sentinel lymph node biopsy. However, there is no consensus regarding the definition of suspicious...
Intraoperative nodal palpation in the axilla is a mandatory part of sentinel lymph node biopsy. However, there is no consensus regarding the definition of suspicious palpable node. The sampling rate and involvement rate of suspicious palpable nodes are inconsistent. We hypothesized that axillary reverse mapping is helpful to select suspicious palpable sentinel lymph nodes more accurately. Patients with clinically negative nodes underwent sentinel lymph node biopsy with intraoperative nodal palpation and axillary reverse mapping. Blue and hot nodes were removed as sentinel lymph nodes. Suspicious palpable nodes that were neither blue nor hot were removed as palpable sentinel lymph nodes. Nodes around blue and hot sentinel lymph node were incidentally removed as para-sentinel lymph nodes. Fluorescent nodes were considered axillary reverse mapping nodes. Patients with positive sentinel lymph node underwent axillary lymph node dissection. Palpable sentinel lymph nodes and para-sentinel lymph nodes were removed in 130 (15%) of 850 patients with clinically negative nodes. Although palpable sentinel lymph nodes and para-sentinel lymph nodes were involved in 19 (15%) of 130 patients, fluorescent palpable sentinel lymph nodes were involved only in 2 patients and fluorescent para-sentinel lymph nodes were not involved. When excluding fluorescent palpable sentinel lymph nodes and para-sentinel lymph nodes, the sampling rate of suspicious palpable nodes significantly decreased (15% vs. 5%, p < 0.01) and the involvement rate of palpable sentinel lymph nodes significantly increased (15% vs. 31%, p < 0.05). Axillary reverse mapping is helpful to avoid an unnecessary removal of palpable nodes without metastases.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Palpation; Sentinel Lymph Node Biopsy
PubMed: 34120393
DOI: 10.1111/tbj.14260 -
Otolaryngologic Clinics of North America Aug 1998Modern imaging for neck node metastases has increased our ability to predict the presence of palpably occult metastases and predict the resectability of large... (Review)
Review
Modern imaging for neck node metastases has increased our ability to predict the presence of palpably occult metastases and predict the resectability of large metastases. The accuracy of CT scans, MR imaging, but especially US-FNAC, has increased to such an extent that clinical consequences are being attached to negative radiologic findings in a clinically N0 neck. As not all palpably occult metastases can be detected, especially when they are micrometers, follow-up should be strict, with use of US-FNAC in the neck observed instead of treated electively.
Topics: Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography
PubMed: 9687324
DOI: 10.1016/s0030-6665(05)70075-x