ABSTRACT: Major airway obstruction due to broncholithiasis produces significant morbidity, and management is difficult. Many of the patients are elderly and are not good candidates for surgical removal. Bronchoscopic removal may be limited due to anatomic considerations, skill of the bronchoscopist, and exposure of the patient to additional procedural risks. Preprocedural planning with three-dimensional (3D) multidetector CT (MDCT) imaging enhances the bronchoscopist's knowledge of the relationships of the target lesions with critical structures, and improves the efficiency of the application of specific endobronchial therapies. Here we report our experience treating obstructing broncholithiasis in two patients utilizing pretreatment planning with 3D MDCT imaging, followed by bronchoscopically delivered holmium laser fragmentation of the stones.
Chest 10/2006; 130(3):909-12. · 5.25 Impact Factor
ABSTRACT: Penile carcinoma is uncommon. Therefore, obtaining meaningful epidemiologic data requires analysis of large, multisource databases. The authors examined the association between different demographic variables and the prevalence, presentation, and survival of patients with penile squamous cell carcinoma in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.
The SEER database represents 12% of the U.S. population. The database included 1605 patients with a diagnosis of penile squamous cell carcinoma between 1973 and 1998. The variables analyzed were age, race, marital status, stage at presentation, type of surgery, performance of lymphadenectomy, and disease-specific survival.
Of 1605 patients, 37% presented with carcinoma in situ (CIS), 39% with localized disease, 13% with regional disease, 2.3% with distant disease, and 7.9% of the patients were unstaged. The percentage of patients presenting with CIS and localized disease increased and decreased yearly, respectively. African Americans represented 9.9% of the population and tended to present at a younger age and with a higher stage of disease, and their cancer-specific survival was shorter in all stages. However, these associations were statistically significant only for men with regional disease. Marital status was documented for 1394 patients (87%). The majority (84%) had a history of marriage and presented at an earlier stage of disease and had higher disease-specific survival in the localized (P = 0.0002) and regional stages (P = 0.0010) of disease.
The diagnosis of penile carcinoma significantly reduced survival. African-American men presented with a higher stage of disease and statistically significant decreased survival, whereas previously or currently married men presented at an earlier stage of disease and sought more aggressive treatment.
Cancer 10/2004; 101(6):1357-63. · 4.77 Impact Factor
The Journal of Urology 04/2002; 167(3):1431-2. · 3.75 Impact Factor