1/29. Primary care screening for prostate cancer.Prostate cancer is second only to lung cancer among killers of men in the United States. Researchers continue to develop tests that are more sensitive for diagnosing prostate cancer. At present, primary care assessment and evaluation of the disease are determined by physical evidence that may not be apparent and by laboratory values that may not be truly reflective of the underlying disease process. Men over the age of 40 need an annual evaluation for increased prostate-specific antigen (PSA) along with a digital rectal examination. Some data suggest that the digital rectal exam and PSA levels may be insensitive indicators of prostate cancer in men with low total or free testosterone levels. The synergistic effect of testosterone on PSA could mask indicators for evaluation of prostate cancer.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/29. Significant medical pathology discovered during a male infertility evaluation.PURPOSE: Because a pregnancy can be achieved without a male infertility evaluation, some have questioned its usefulness. However, by bypassing a urological evaluation the man might not learn the cause of infertility and not be offered specific corrective therapy. In addition, men with subfertility may have a serious underlying medical or genetic problem that could also be overlooked. We determine the incidence of significant medical pathology discovered during a male infertility evaluation at 2 academic infertility practices. MATERIALS AND methods: All men examined for either primary or secondary infertility were included in our study, while men seen for vasectomy reversal were not. All patients underwent evaluation, consisting of a complete history, physical examination, semen analysis, hormone testing, urinalysis and genetic testing when appropriate. RESULTS: Significant medical pathology was discovered in 33 of 536 (6%) patients. A total of 27 patients had genetic abnormalities, including cystic fibrosis mutations in 24 and karyotypic abnormalities in 3. Of the remaining 6 patients 1 had testis cancer, 1 prostate cancer, 3 diabetes mellitus and 1 hypothyroidism. CONCLUSIONS: Significant medical pathology can be detected by a male infertility evaluation. In addition to identifying the cause of infertility, the evaluation may uncover conditions that threaten the health of the male partner or any potential offspring.- - - - - - - - - - ranking = 8.7868363474187keywords = physical examination, physical (Clic here for more details about this article) |
3/29. Temporary PSA rises and repeat prostate biopsies after brachytherapy.PURPOSE: The long-standing confusion regarding the clinical relevance of postimplant biopsies is complicated by the common occurrence of temporary PSA rises between 1 and 2 years after brachytherapy. We report here 4 patients with temporary, self-limited PSA rises and postimplant biopsies, for whom radical prostatectomy was strongly advised but for whom surgery would probably have been the wrong choice. MATERIALS AND methods: Transperineal I-125 or Pd-103 implants were performed as previously described. After implantation, patients were followed routinely, with repeat PSA and physical examination at approximately every 4 to 6 months. Timing of postimplant PSAs was at the discretion of the patient and his doctors. Postimplant biopsies were performed in all cases out of concern for a persistently elevated serum PSA. Sections of fixed and embedded tissue were stained with standard hematoxylin and eosin. RESULTS: All 4 patients presented here were advised to have a salvage prostatectomy based primarily on their PSA changes. However, all of the patients have subsequently had a dramatic PSA fall, consistent with long-term cancer control, despite the fact that 3 of the 4 had histologic evidence of persistent cancer on repeat prostate biopsy. CONCLUSIONS: It is crucial that clinicians be aware of the potential for the doubly confusing situation of temporary PSA rises and apparently positive rebiopsies and the pressure it puts on both patients and their physicians to go ahead with inappropriate salvage therapy.- - - - - - - - - - ranking = 8.7868363474187keywords = physical examination, physical (Clic here for more details about this article) |
4/29. Transdural metastasis from adenocarcinoma of the prostate mimicking subdural hematoma: case report.BACKGROUND: Metastasis of prostatic adenocarcinoma to the nervous system is extremely rare and has been infrequently reported over the last several years. We describe the presentation, evaluation, and surgical intervention of a case of metastatic prostate carcinoma to the dura. CASE DESCRIPTION: This patient presented with symptoms and physical findings consistent with a subacute subdural hematoma in the setting of recently diagnosed adenocarcinoma of the prostate. He underwent a craniotomy for presumed subdural hematoma. The pathologic diagnosis was consistent with metastatic prostatic carcinoma. CONCLUSION: This case report demonstrates the need for broad differential diagnosis in the evaluation and treatment of patients presenting with seemingly straightforward subacute subdural hematomas.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/29. Prostate adenocarcinoma presenting with inguinal lymphadenopathy.The lymphatic spread of prostate adenocarcinoma most often involves the iliac, obturator, and hypogastric nodes. Inguinal lymphadenopathy is very rare during the early stages of this disease, especially in the absence of pelvic lymphadenopathy or other metastases. We present a case of prostate adenocarcinoma with inguinal node involvement during the initial presentation, emphasizing the importance of a complete physical examination and the consideration of other concurrent diseases.- - - - - - - - - - ranking = 8.7868363474187keywords = physical examination, physical (Clic here for more details about this article) |
6/29. male genital schwannoma, review of 5 cases.AIM: To study the clinical features of male genital schwannoma. methods: Five male patients with genital schwannoma admitted from 1991 to 2000 were reviewed. The lesions were located in the prostate, spermatic cord, testis or penis. Tumors were simply resected in 3 patients and radically eradicated in 2. RESULTS: The average age of the cohort was 37 years. The most common sign at presentation was a palpable genital mass accidentally discovered by the patient or detected by the physician during a physical check. diagnosis was made through postoperative pathological examination. Follow-up ranged from 2 years to 6 years (mean 4.5 years). Four cases were cured by simple excision and 1 patient with malignant testis schwannoma died of recurrence 1 year after surgery. CONCLUSION: Owing to the lack of characteristic clinical manifestation, the final diagnosis relies on postoperative pathological examination. S-100 and vimentin are useful markers for the diagnosis of these tumors.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/29. Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome): a report of two cases and review of the literature.We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE) associated with prostatic adenocarcinoma. One of the patients was positive for helicobacter pylori and the other had secondary bone metastases. In the latter, the clinical picture of RS3PE developed after surgical intervention for the primary lesion. On physical examination, while the hands and feet were swollen in the first patient, pitting edema was present only at the feet of the other. All joints of the affected hands and feet were painful. Serological tests including rheumatoid factor, antinuclear antibody, and human leukocyte antigen B27 were all negative. Response to low-dose corticosteroid treatment was delayed in the first patient, but the symptoms were relieved better in the second one.- - - - - - - - - - ranking = 8.7868363474187keywords = physical examination, physical (Clic here for more details about this article) |
8/29. Fine-needle aspiration diagnosis of plasmacytoma presenting as breast masses in a patient on estrogen therapy for prostate cancer.We describe a 79-yr-old man with a history of androgen-independent metastatic prostate cancer treated with exogenous estrogens presenting with bilateral breast masses associated with bilateral axillary lymphadenopathy. Although the findings on physical examination with the concomitant history of estrogen therapy for metastatic prostate cancer raised the clinical suspicion of breast cancer, fine-needle aspiration (FNA) cytology identified the lesions as multiple myeloma.- - - - - - - - - - ranking = 8.7868363474187keywords = physical examination, physical (Clic here for more details about this article) |
9/29. Gastrointestinal stromal tumor of the prostate.We present a unique case of an atypical prostate tumor in a 49-year-old man with acute urinary retention. digital rectal examination revealed a large prostate with a parenchymal mass on the left side. Radiologic imaging showed a 14.2 x 9.6 x 14.0-cm prostatic mass and multiple liver metastases. A pathologic diagnosis of a prostatic gastrointestinal stromal tumor was made and was confirmed by molecular analysis. Therapy consisted of a tyrosine kinase inhibitor, resulting in prostate mass reduction. After 100 weeks, the patient was in good physical condition with a continuing partial response with a reduced mass volume and liver nodules.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/29. Simultaneous extraperitoneal laparoscopic radical prostatectomy and intraperitoneal inguinal hernia repair with mesh.OBJECTIVE: This report depicts the feasibility of the concomitant repair of a large direct inguinal hernia with mesh by using the intraperitoneal onlay approach after extraperitoneal laparoscopic radical prostatectomy. methods: A 66-year-old man with localized adenocarcinoma of the prostate was referred for laparoscopic radical prostatectomy. The patient also had a 4-cm right, direct inguinal hernia, found on physical examination. To minimize the risk of infection of the mesh, an extraperitoneal laparoscopic prostatectomy was performed in the standard fashion after which transperitoneal access was obtained for the hernia repair. The hernia repair was completed by reduction of the hernia sac, followed by prosthetic mesh onlay. In this fashion, the peritoneum separated the prostatectomy space from the mesh. A single preoperative and postoperative dose of cefazolin was administered. RESULTS: The procedure was completed with no difficulty. Total operative time was 4.5 hours with an estimated blood loss of 450 mL. The final pathology revealed pT2cN0M0 prostate cancer with negative margins. No infectious or bowel complications occurred. At 10-month follow-up, no evidence existed of recurrence of prostate cancer or the hernia. CONCLUSION: Concomitant intraperitoneal laparoscopic mesh hernia repair and extraperitoneal laparoscopic prostatectomy are feasible. This can decrease the risk of potential infectious complications by separating the mesh from the space of Retzius where the prostatectomy is performed and the lower urinary tract is opened.- - - - - - - - - - ranking = 8.7868363474187keywords = physical examination, physical (Clic here for more details about this article) |
| | Next -> |