J P Spirnak

Aultman Hospital, Canton, Ohio, United States

Are you J P Spirnak?

Claim your profile

Publications (56)142.91 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To report biochemical disease-free survival (bDFS) after conformal brachytherapy with dose escalation to biological target volumes (BTVs) identified by Capromab Pendetide with single photon emission computed tomography and computed tomography image fusion (SPECT/CT). Two hundred thirty-nine (T1c-T3b NxM0) consecutive patients were evaluated by SPECT/CT before treatment. Intraprostatic SPECT/CT BTVs were identified and targeted for 150% dose escalation during brachytherapy seed implant (SI). Patients received either SI alone (n = 150) or external beam radiation therapy (EBRT) plus SI boost (EBRT+SI) (n = 89), with (n = 50) and without (n = 189) neoadjuvant hormone ablation therapy. Risk factors (RF) (prostate-specific antigen [PSA] >10 ng/mL, Stage > or = T2b, and Gleason grade > or = 7) defined risk group (RG) categories [none, 1, and > or = 2 RF define low, intermediate, and high RG] for bDFS calculations using four failure criteria: American Society for Therapeutic Radiology and Oncology (ASTRO) consensus definition, PSA >1.0 ng/mL (PSA >1), PSA >0.5 ng/mL after nadir (PSA >0.5), and PSA nadir+2 ng/mL rise in PSA clinical nadir (CN+2). Median followup was 47.2 months (range, 24.8-96.1). Seven-year actuarial bDFS rates were 88.0%, 82.1%, 80.4%, and 79.9% using the ASTRO, PSA >1, PSA >0.5, and CN+2 failure criteria, respectively. ASTRO-defined bDFS rates were 96.0%, 87.0%, and 72.5% for low, intermediate, and high RG's. The data presented here demonstrate the feasibility of performing SPECT/CT BTV dose escalation in a mature series.
    Brachytherapy 01/2007; 6(1):16-25. · 1.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate rectal morbidity after dose escalation to biologic target volumes identified by capromab pendetide (ProstaScint) single-photon emission tomography images coregistered with computed tomography (SPECT/CT). Two hundred thirty-nine consecutive patients diagnosed with T1c-T3b NxM0 adenocarcinoma of the prostate were treated with brachytherapy seed implant (SI) dose escalation to SPECT/CT-identified biologic target volumes, from February 1997 through December 2002. Patients received SI (n=150) or external beam radiation therapy plus SI (n=89). Rectal morbidity was evaluated by clinician scoring using the modified Radiation Therapy Oncology Group criteria. The median followup was 47.2 (range 24.8-96.1) months. The rate of acute Grades I and II toxicity was 29.9% and 3.7%, respectively, and chronic Grade I toxicity was 15.4%, 12.4%, 2.3%, and 1.8% at 1, 2, 3, and 4 years postimplant, respectively. Chronic Grade II toxicities were 1.8%, 1.9%, 1.5%, and 0.9% at 1, 2, 3, and 4 years, respectively. No Grade III rectal toxicity was reported. Chronic Grade IV rectal toxicity was 0.5% and 0.6% at 1.5 and 2.5 years, respectively. Ninety-six percent of patients reported freedom from all rectal toxicity after 3 years. Dose intensification to occult tumor targets without increasing rectal toxicity may be achieved using SPECT/CT ProstaScint. Additional research to define the role of molecular imaging in prostate cancer is warranted.
    Brachytherapy 01/2007; 6(2):149-56. · 1.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate 4-year biochemical outcomes for patients with prostate adenocarcinoma who underwent radioimmunoguided (Prostascint) permanent prostate brachytherapy. Eighty patients with clinical T1C-T3A NxM0 prostate cancer underwent ProstaScint-guided prostate brachytherapy using either (103)Pd or (125)I between February 1997 and December 2000. Sixty-seven patients underwent prostate brachytherapy alone, whereas 13 patients received neoadjuvant hormonal manipulation before implantation. Risk factors (RF) included PSA >10, Stage >or=T2b, and Gleason grade >or=7. Sixty patients had low-risk disease (0 RF), 17 were intermediate risk (1 RF), and 3 were high risk (2 RF). Biochemical disease-free survival (bDFS) was calculated using the American Society for Therapeutic Radiology and Oncology (ASTRO) consensus criteria, a PSA cutoff of 1.0 ng/mL, and a PSA cutoff of 0.5 ng/mL. Four-year bDFS for the entire cohort was 97.4% using the ASTRO consensus criteria. Low-risk patients (60) had a 4-year bDFS of 100%; intermediate- and high-risk patients (20 patients) were 89.2%. The hormonally naïve group (67 patients) had a 4-year bDFS of 96.9% and a median PSA nadir of 0.2 ng/mL. Median time to nadir was 19.8 months (range: 1.9-53.2 months). For the neoadjuvant hormonal therapy group (13 patients), ASTRO-defined bDFS was 100%. Overall, 85.2% of patients had a posttreatment PSA <or=1.0 ng/mL, and 75.9% had a PSA <or=0.5 ng/mL at a median follow-up of 36 months. At a median follow-up of 36 months, ProstaScint-guided transperineal brachytherapy results in a high probability of actuarial 4-year biochemical disease-free survival for patients with localized prostate cancer.
    International Journal of Radiation OncologyBiologyPhysics 10/2003; 57(2):362-70. · 4.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report outcomes for prostate cancer patients treated with external beam radiation therapy (EBRT) and permanent prostate brachytherapy utilizing radioimmunoguided targeting of biological tumor volumes (BTVs). Between February 1997 and October 2001, 66 patients with intermediate- to high-risk prostate cancer underwent EBRT and ProstaScint-guided transperineal brachytherapy. Thirty patients received neoadjuvant hormonal manipulation, while 36 patients did not. Median patient age was 66 years (range, 49-78 years). The median follow-up was 41 months (range, 24-78 months). No patients were lost to follow-up. Risk factors (RF) used for risk stratification included PSA >10 ng/ml (35 patients), Stage T2b or greater (22 patients), and Gleason score > or = 7 (55 patients). Results for biochemical disease free survival (bDFS) were reported using the ASTRO consensus definition for biochemical failure, PSA < or = 1.0 ng/mL or PSA< or = 0.5 ng/mL. Survival was estimated by the Kaplan-Meier method. Five-year overall survival was 93.1% and 5-year bDFS by the ASTRO definition was 89.3% with a median follow up of 41 months. Patients with intermediate- (1 RF) and high-risk (2-3 RF) prostate cancer exhibited 5-year ASTRO-defined bDFS of 100% and 81.9%, respectively. There was no significant difference in bDFS between the patients treated with or without hormone therapy (HT). The 5-year ASTRO-defined bDFS was 89.8% for the 30 patients treated with HT and 88.9% for the 36 patients who did not receive HT (p = 0.843). For the patients without HT the median PSA nadir was 0.11 ng/mL. The median time to nadir was 23 months (range, 6-66 months). With limited follow-up, the results of EBRT plus radioimmunoguided brachytherapy for intermediate- to high-risk prostate cancer appear favorable. The addition of HT did not appear to affect bDFS significantly, but interpretation is confounded by possible selection bias and the limited power of this study.
    Brachytherapy 01/2003; 2(4):215-22. · 1.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As a result of the rapid increase in medical costs, the efficacy of diagnostic imaging is under examination, and efforts have been made to identify patients who may safely be spared radiographic imaging. We reviewed the records of children who presented to our institution with suspected blunt renal injuries to determine if radiographic evaluation is necessary in children with microscopic hematuria and blunt renal trauma. We retrospectively reviewed the medical records of 1200 children (ages less than 18 years) who sustained blunt abdominal trauma and who presented to our level I pediatric trauma center between 1995 and 1997. Urinalysis was performed in 299 patients (25%). Urinalysis results were correlated with findings on abdominal computed tomography (CT). All patients had more than three red blood cells per high power field (RBC/ hpf) or gross hematuria. Renal injuries were graded according to the injury scale defined by the American Association for the Surgery of Trauma. Sixty-five patients had microscopic hematuria. Thirty-five (54%) were evaluated with an abdominal CT scan. Three patients sustained significant renal injuries (grade II-V), and 32 patients had normal findings or renal contusions. Therefore only 3 of 65 patients (4.6%) sustained a significant renal injury. All three patients had other associated major organ injuries. Of the three patients with gross hematuria evaluated with abdominal CT, one (33%) sustained a significant renal injury and had no associated injuries. The degree of hematuria did not correlate with the grade of renal injury. Pediatric patients with blunt trauma, microscopic hematuria, and no associated injuries do not require radiologic evaluation, as significant renal injuries are unlikely. However, children who present with associated injuries and microscopic hematuria after blunt trauma may have significant renal injuries and should undergo radiologic evaluation.
    World Journal of Surgery 01/2002; 25(12):1557-60. · 2.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We have previously presented a technique that fuses ProstaScint and pelvic CT images for the purpose of designing brachytherapy that targets areas at high risk for treatment failure. We now correlate areas of increased intensity seen on ProstaScint-CT fusion images to biopsy results in a series of 7 patients to evaluate the accuracy of this technique in localizing intraprostatic disease. The 7 patients included in this study were evaluated between June 1998 and March 29, 1999 at Metrohealth Medical Center and University Hospitals of Cleveland in Cleveland, Ohio. ProstaScint and CT scans of each patient were obtained before transperineal biopsy and seed implantation. Each patient's prostate gland was biopsied at 12 separate sites determined independently of Prostascint-CT scan results. When correlated with biopsy results, our method yielded an overall accuracy of 80%: with a sensitivity of 79%, a specificity of 80%, a positive predictive value of 68%, and a negative predictive value of 88%. The image fusion of the pelvic CT scan and ProstaScint scan helped identify foci of adenocarcinoma within the prostate that correlated well with biopsy results. These data may be useful to escalate doses in regions containing tumor by either high-dose rate or low-dose rate brachytherapy, as well as by external beam techniques such as intensity modulated radiotherapy (IMRT).
    International Journal of Radiation OncologyBiologyPhysics 05/2001; 49(5):1281-6. · 4.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present a technique that fuses pelvic CT scans and ProstaScint images to localize areas of disease within the prostate gland to customize prostate implants. Additionally, the acute toxicity results from the first 43 patients treated with this technique are reviewed. Between 2/97 and 8/98, 43 patients with clinical stage II prostate adenocarcinoma received ultrasound-guided transperineal implantation of I-125 or Pd-103 seeds. The median patient age was 70 years (range 49-79). Prior to treatment, the median Gleason score and prostate-specific antigen (PSA) were 6 (range 3-8) and 7.5 (range 1.8-16.6 ng/mL), respectively. The median follow-up was 10 months (range 2.9-20.4 months). The median PSA value at 10 months is 0.7 ng/mL. Significant acute complications within the first month following implantation included 13 Grade I urinary symptoms, 24 Grade II urinary symptoms, 6 Grade III symptoms, and no Grade IV complications. Beyond 4 months, complications included 12 Grade I urinary symptoms, 17 Grade II urinary symptoms, 1 Grade III, and 1 Grade IV complications. The image fusion of the pelvic CT scan and ProstaScint scans helped identify regions within the prostate at high risk of local failure, which were targeted with additional seeds during implantation.
    International Journal of Radiation OncologyBiologyPhysics 11/2000; 48(3):683-7. · 4.52 Impact Factor
  • A L Altman, C Haas, K H Dinchman, J P Spirnak
    [Show abstract] [Hide abstract]
    ABSTRACT: We determined the feasibility of a nonoperative approach to blunt grade 5 renal injury. We retrospectively reviewed the records of all patients with grade 5 renal injury who presented to our level 1 trauma center from 1993 to 1998. Those treated nonoperatively and surgically were assigned to groups 1 and 2, respectively. Each group was compared with respect to the initial emergency department evaluation, computerized tomography findings, associated injuries, duration of hospital stay and intensive care unit stay, transfusion requirements, complications and followup imaging. Of 218 renal injuries evaluated 13 were grade 5. In group 1, 6 patients were treated nonoperatively and in group 2, 7 underwent exploration. Each group had similar average hospitalization (12.0 and 12.8 days, respectively). Patients in group 1 had fewer intensive care unit days (4.3 versus 9.0), significantly lower transfusion requirements (2.7 versus 25.2 units, p = 0.0124) and fewer complications during the hospital course. Followup computerized tomography of nonoperatively managed cases revealed functioning renal parenchyma with resolution of retroperitoneal hematoma. Conservative management of blunt grade 5 renal injury is feasible in patients who are hemodynamically stable at presentation.
    The Journal of Urology 08/2000; 164(1):27-30; discussion 30-1. · 3.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Computerized tomography (CT) of the abdomen and pelvis is often routine in the preoperative staging assessment of invasive transitional cell carcinoma of the bladder. We determine the accuracy of staging CT findings, usefulness before planned extirpative surgery and impact on surgical management of this disease. We retrospectively reviewed the medical records, including radiographic, operative and pathological reports, of 82 consecutive cases. All patients presented with muscle invasive bladder tumors, were considered candidates for radical cystectomy and underwent preoperative staging CT of the abdomen and pelvis between July 1994 and June 1998. The ability of CT to provide additional staging information in terms of depth of tumor invasion, local extent of tumor, pelvic lymph node involvement and distant metastases was examined. We determined whether CT findings altered surgical management for individual patients. CT was able to discriminate depth of invasion in only 1 patient (1.2%) and correctly identified extravesical tumor spread in 4 (4.9%). Lymph node and distant metastases were accurately determined in 4 (4.9%) and 2 (2.4%) cases, respectively. The overall accuracy of CT was 54. 9%, with an under staging and over staging rate of 39.0% and 6.1%, respectively. CT provided accurate, additional staging information in only 8 cases (9.8%). Surgical management was altered in 3 cases (3.7%) and only 1 (1.2%) avoided an unnecessary operation as a result of CT findings. Staging CT of the abdomen and pelvis in patients with invasive bladder carcinoma has limited accuracy, mainly because of its inability to detect microscopic or small volume extravesical tumor extension and lymph node metastases. CT tends to under stage advanced disease and failed to alter surgical management in nearly all of our cases.
    The Journal of Urology 07/2000; 163(6):1693-6. · 3.70 Impact Factor
  • C A Haas, J Newman, J P Spirnak
    Urology 10/1999; 54(3):559-60. · 2.42 Impact Factor
  • C A Haas, S L Brown, J P Spirnak
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluate the accuracy of spiral computerized tomography (CT) in diagnosing traumatic bladder rupture. Medical records of 24 consecutive patients diagnosed with traumatic bladder rupture at our level 1 trauma center from 1993 to 1998 were retrospectively reviewed. Of the patients 15 underwent retrograde cystography and spiral CT of the abdomen and pelvis. The results of these imaging studies were compared. Retrograde cystography successfully diagnosed all cases of bladder rupture and correctly classified injuries confirmed surgically. Spiral CT successfully diagnosed 9 of 15 bladder ruptures (60%), and correctly classified 4 of 5 intraperitoneal (80%) and 6 of 11 extraperitoneal (55%) ruptures. Spiral CT is less accurate than retrograde cystography in diagnosing traumatic bladder rupture.
    The Journal of Urology 08/1999; 162(1):51-2. · 3.70 Impact Factor
  • C A Haas, S L Brown, J P Spirnak
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic injuries to the penis and testicles are uncommon, likely due to the well-protected location and degree of mobility of these organs. Because of this the management of these injuries has historically been controversial. However, current literature supports immediate evaluation and surgical repair of these traumatic injuries to prevent complications such as erectile dysfunction or testicular loss. Herein the diagnostic and therapeutic options for both traumatic penile fracture and testicular rupture are reviewed with emphasis on immediate evaluation and repair.
    World Journal of Urology 05/1999; 17(2):101-6. · 2.89 Impact Factor
  • S L Brown, D M Hoffman, J P Spirnak
    [Show abstract] [Hide abstract]
    ABSTRACT: We have observed that injury to the renal collecting system may be missed during routine abdominal spiral computerized tomography (CT) for trauma. A definitive protocol for spiral CT has been established to identify all cases of renal collecting system injury. A retrospective review of 35 consecutive cases of blunt renal trauma evaluated with spiral CT between 1994 and 1997 at our Level I trauma center was performed. Each patient received 100 cc intravenous contrast at 2 cc per second. There was a 60-second delay after the start of contrast infusion before scanning was initiated. Of the 35 cases 3 (8.6%) injuries to the renal collecting system were detected on delayed scans obtained after the initial CT failed to demonstrate contrast extravasation. Therefore, at our institution we have modified the protocol for spiral CT for abdominal trauma by repeating scans of the kidneys after the initial scans are completed. Injury to the renal collecting system may be missed during routine spiral CT, thereby incorrectly under staging renal trauma. In all cases of suspected blunt renal trauma evaluated with spiral CT repeat scans of the kidneys should be performed.
    The Journal of Urology 01/1999; 160(6 Pt 1):1979-81. · 3.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Five patients with major (Grade IV) renal trauma required ureteral stent placement to facilitate urinary drainage. Three of these patients had stents placed for recurrent gross hematuria with flank pain. All three had obstructing blood clots present at the time of stent placement. The fourth patient had a stent placed because of persistent extravasation at 2 weeks postinjury. The last patient was considered at risk for persistent urinary extravasation because of a partial ureteropelvic junction obstruction and had a ureteral stent placed as part of the initial management. All patients were followed radiographically for resolution of extravasation. Long-term clinical follow-up consisted of serum creatinine evaluation and blood pressure monitoring. Urinary extravasation resolved in all five patients, as determined by radiologic evaluation, at a mean of 8 days after stent placement. Ureteral stents were left indwelling an average of 4 weeks. No patient developed hypertension, and all serum creatinine values were normal at a mean 26 months' follow-up. No patient developed urinoma or abscess, and none required open surgical exploration. Ureteral stents may be used safely and effectively to treat persistent or recurrent urinary extravasation resulting from major blunt renal trauma in appropriately selected patients. In addition, ureteral stents may avoid the need for surgical exploration in patients with Grade IV renal trauma who develop recurrent gross hematuria, flank pain, and persistent or recurrent extravasation secondary to clot obstruction.
    Journal of Endourology 01/1999; 12(6):545-9. · 2.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: ProstaScint (Cytogen Corporation, Princeton, NJ) murine monoclonal antibody imaging is FDA-approved for imaging of prostate cancer patients at high risk for metastatic disease and patients postprostatectomy with a rising serum prostate-specific antigen (PSA) level. ProstaScint is a murine monoclonal antibody which targets prostate-specific membrane antigen (PSMA). PSMA expression is upregulated in primary and metastatic prostate cancer. FDA Cytogen (Princeton, NJ) protocol studies using 111indium-labeled ProstaScint revealed correlation between areas of increased concentration in the prostate and biopsy-proven tumors in patients imaged pretherapy. In our study, four transverse, single-photon emission tomography (SPECT) images were isolated and regions of interest were selected and correlated with pretherapy prostate biopsy results. Prostate cancer and normal tissue prostate/muscle background (P/M) ratios were derived, so that postprostatectomy/radiation therapy patients could be evaluated for the presence of residual prostate cancer. Twenty-three pretherapy prostate cancer patients with quadrant/sextant biopsies had SPECT 96-hr 111indium ProstaScint pelvic images. The four transverse 1-cm slices above the midline penile blood pool were chosen, and four to six 27-30-pixel regions of interest were placed over the prostate bed. The background muscle region of interest was placed over the external obturator muscle region. The P/M ratio was calculated and compared to the quadrant/sextant prostatic biopsy result. The same procedure was applied to 17 posttherapy prostate cancer patients with rising PSA. In the 23 pretherapy prostate cancer patients, there was a correlation between the P/M ratio of at least 3.0 in 32 of 35 prostatic cancer biopsy regions, and there was correlation with P/M ratios less than 3.0 in 82 of 89 negative biopsy regions. Seventeen posttherapy patients underwent ProstaScint studies. Six underwent biopsy, with typically one biopsy site per patient. All 6 had P/M ratios greater than 3.0 in the biopsied region. Five out of six biopsies revealed residual prostate cancer. A prostate/muscle ratio was developed from 111indium ProstaScint regions of interest obtained on 1-cm SPECT transverse slices through the prostate bed in 23 patients preprostatic cancer therapy. A P/M ratio above 3.0 correlated in the majority of positive cases, and a P/M ratio below 3.0 was demonstrated in negative prostatic biopsy cases. The P/M ratio of above 3.0 or below 3.0 also separated those posttherapy prostate cancer patients with rising PSA who had residual prostate carcinoma in the prostate bed.
    The Prostate 12/1998; 37(3):140-8. · 3.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To better define what constitutes appropriate treatment for traumatic renal artery occlusion, we report our 15-year experience in managing this injury. A retrospective chart review was performed to evaluate treatment outcomes and complications of 12 patients (13 injuries) who presented to our trauma centers with renal artery occlusion secondary to blunt injury. Five of 12 patients underwent attempted surgical revascularization with a median warm ischemia time of 5 hours (range, 4.5-36 hours). Of these five patients, one required nephrectomy for inability to establish arterial flow, three demonstrated no function, and one had return to 9% differential function on postoperative renal scan. Seven patients did not have attempted revascularization, and none of them experienced immediate complications. Hypertension developed in three patients (43%) who required nephrectomy to control blood pressure at a mean of 5 months after injury (range, 3-7 months). Four patients remained asymptomatic and normotensive at a mean follow-up of 11 months (range, 4 weeks to 2.6 years). Surgical revascularization for traumatic renal artery occlusion seldom results in a successful outcome. Patients who are observed must have close follow-up for hypertension.
    The Journal of trauma 10/1998; 45(3):557-61. · 2.35 Impact Factor
  • S L Brown, J S Elder, J P Spirnak
    [Show abstract] [Hide abstract]
    ABSTRACT: We determine whether pediatric patients are more susceptible to major renal injury than adults. We retrospectively reviewed the medical records of 34 consecutive children 2 to 17 years old (mean age 10) and 35 consecutive adults 19 to 59 years old (mean age 32) with blunt renal trauma who presented to our 2 level I trauma centers between 1990 and 1996. Patients with incomplete charts were excluded from study. According to the organ injury scaling committee of the American Association for the Surgery of Trauma renal injuries were graded based on computerized tomography results or laparotomy findings (4 adults) with major injuries classified as grade IV or V. Vascular injuries were excluded from study. Injury severity scores were calculated using the abbreviated injury scale. Injury severity scores ranged from 4 to 75 (mean 16) in the pediatric and 5 to 50 (mean 22) in the adult populations (p <0.01). Overall 16 of the 34 children (47%) and 8 of the 35 adults (23%) sustained major renal injuries (p <0.04). In 4 children who required surgical exploration for hemodynamic instability injury severity score ranged from 17 to 42 (mean 26) and all had major renal injuries. In 7 of the 35 adults (20%) who underwent surgical exploration because of hemodynamic instability and/or positive diagnostic peritoneal lavage injury severity score ranged from 22 to 50 (mean 34). Three of these 7 adults (42%) had major renal injuries and all had other visceral injuries at exploration. Children are more likely than adults to sustain renal injury from blunt abdominal trauma.
    The Journal of Urology 08/1998; 160(1):138-40. · 3.70 Impact Factor
  • R I Patel, C Haas, J P Spirnak, C Erhardt
    The Journal of Urology 07/1998; 159(6):2089-90. · 3.70 Impact Factor
  • C A Haas, J P Spirnak
    [Show abstract] [Hide abstract]
    ABSTRACT: To better define what constitutes appropriate treatment for traumatic renal artery occlusion, we analyzed our experience along with 147 other case reports from the literature. We recently reported our 15-year experience with 12 patients (13 injuries) who presented to our trauma centers with renal artery occlusion secondary to blunt trauma. This experience prompted a review of the literature. From this review, we identified an additional 19 cases of bilateral and 128 cases of unilateral renal artery occlusion that met our inclusion criteria. Of the 20 patients with bilateral renal artery occlusion, surgical revascularization was attempted in 16 and successful in 9 (56%). Of the 139 patients with unilateral renal artery occlusion, surgical revascularization was attempted in 34 and successful in 9 (26%). Evidence of decreased renal function was noted in 67% of those who had a successful revascularization for unilateral injury at a mean 1.8-year follow-up, whereas 12% experienced hypertension at a mean 3.1-year follow-up. Hypertension developed in 34 (32%) of the 105 patients who did not have revascularization attempted and was present by a mean 97 days postinjury. Surgical revascularization for unilateral renal artery occlusion seldom results in a successful outcome. Revascularization is indicated in patients with bilateral renal artery occlusion and in those with injury to a solitary kidney. Patients who are observed must be followed closely for development of hypertension.
    Techniques in urology 04/1998; 4(1):1-11.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The development and advances in extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open surgery in the treatment of renal and ureteral stones. We reviewed our experience with open stone surgery to determine the current indications and efficacy of this treatment modality. Hospital and office charts, operative notes and records, and pertinent radiographic studies of all patients undergoing open stone surgery from January 1991 through December 1995 at 3 university affiliated hospitals were reviewed. Patient characteristics, stone burden, indications, surgical factors and outcomes were reviewed for each patient. Of 780 procedures performed for stone removal, 42 were open surgical procedures (5.4%) including pyelolithotomy in 15 (extended pyelolithotomy or pyelonephrolithotomy in 7), anatrophic nephrolithotomy in 14, ureterolithotomy in 7 and radial nephrolithotomy in 6. There were 24 men and 18 women ranging in age from 1 to 90 years (mean age 51.5). The most common indications for open surgery were complex stone burden (55%); failure of extracorporeal shock wave lithotripsy or endourological treatment (29%); anatomic abnormalities such as ureteropelvic junction obstruction, infundibular stenosis and/or renal caliceal diverticulum (24%); morbid obesity (10%) and co-morbid medical disease (7%). Mean estimated blood loss was 428 cc. Average hospital stay was 6.4 days. The stone-free rate after surgery was 93%. Five patients had minor postoperative complications that resolved with appropriate therapy. While most patients with renal and ureteral stones can be treated with less invasive techniques, open stone surgery continues to represent a reasonable alternative for a small segment of the urinary stone population.
    The Journal of Urology 03/1998; 159(2):374-8; discussion 378-9. · 3.70 Impact Factor

Publication Stats

1k Citations
142.91 Total Impact Points


  • 2003–2007
    • Aultman Hospital
      Canton, Ohio, United States
  • 1995–2007
    • MetroHealth Medical Center
      Cleveland, Ohio, United States
  • 1984–2007
    • Case Western Reserve University
      • • Department of Radiation Oncology (University Hospitals Case Medical Center)
      • • MetroHealth Medical Center
      • • Department of Urology (University Hospitals Case Medical Center)
      • • School of Medicine
      Cleveland, OH, United States
  • 1989–2003
    • Case Western Reserve University School of Medicine
      • Department of Urology
      Cleveland, Ohio, United States
  • 1999
    • Metro Health Hospital
      Wyoming, Michigan, United States