Urologists
42 years of experience
Video profile
Accepting new patients
360 Essex St
Ste 403
Hackensack, NJ 07601
551-996-8090
Locations and availability (1)

Education ?

Medical School Score Rankings
Georgetown University (1968)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Patients' Choice Award (2013)
Top 10 Doctor - City (2014)
Hackensack, NJ
Urologist
Associations
American Board of Urology
American Urological Association

Affiliations ?

Dr. Watson is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Hackensack University Medical Center
    Urology
    30 Prospect Ave, Hackensack, NJ 07601
    • Currently 4 of 4 crosses
    Top 25%
  • Pascack Valley Hospital
    250 Old Hook Rd, Westwood, NJ 07675
    • Currently 3 of 4 crosses
    Top 50%
  • Hackensackuniversity Medical Center
  • Publications & Research

    Dr. Watson has contributed to 35 publications.
    Title "if You Can't Be with the One You Love, Love the One You're With": How Individual Habituation of Agent Interactions Improves Global Utility.
    Date September 2011
    Journal Artificial Life
    Excerpt

    Simple distributed strategies that modify the behavior of selfish individuals in a manner that enhances cooperation or global efficiency have proved difficult to identify. We consider a network of selfish agents who each optimize their individual utilities by coordinating (or anticoordinating) with their neighbors, to maximize the payoffs from randomly weighted pairwise games. In general, agents will opt for the behavior that is the best compromise (for them) of the many conflicting constraints created by their neighbors, but the attractors of the system as a whole will not maximize total utility. We then consider agents that act as creatures of habit by increasing their preference to coordinate (anticoordinate) with whichever neighbors they are coordinated (anticoordinated) with at present. These preferences change slowly while the system is repeatedly perturbed, so that it settles to many different local attractors. We find that under these conditions, with each perturbation there is a progressively higher chance of the system settling to a configuration with high total utility. Eventually, only one attractor remains, and that attractor is very likely to maximize (or almost maximize) global utility. This counterintuitive result can be understood using theory from computational neuroscience; we show that this simple form of habituation is equivalent to Hebbian learning, and the improved optimization of global utility that is observed results from well-known generalization capabilities of associative memory acting at the network scale. This causes the system of selfish agents, each acting individually but habitually, to collectively identify configurations that maximize total utility.

    Title Global Adaptation in Networks of Selfish Components: Emergent Associative Memory at the System Scale.
    Date September 2011
    Journal Artificial Life
    Excerpt

    In some circumstances complex adaptive systems composed of numerous self-interested agents can self-organize into structures that enhance global adaptation, efficiency, or function. However, the general conditions for such an outcome are poorly understood and present a fundamental open question for domains as varied as ecology, sociology, economics, organismic biology, and technological infrastructure design. In contrast, sufficient conditions for artificial neural networks to form structures that perform collective computational processes such as associative memory/recall, classification, generalization, and optimization are well understood. Such global functions within a single agent or organism are not wholly surprising, since the mechanisms (e.g., Hebbian learning) that create these neural organizations may be selected for this purpose; but agents in a multi-agent system have no obvious reason to adhere to such a structuring protocol or produce such global behaviors when acting from individual self-interest. However, Hebbian learning is actually a very simple and fully distributed habituation or positive feedback principle. Here we show that when self-interested agents can modify how they are affected by other agents (e.g., when they can influence which other agents they interact with), then, in adapting these inter-agent relationships to maximize their own utility, they will necessarily alter them in a manner homologous with Hebbian learning. Multi-agent systems with adaptable relationships will thereby exhibit the same system-level behaviors as neural networks under Hebbian learning. For example, improved global efficiency in multi-agent systems can be explained by the inherent ability of associative memory to generalize by idealizing stored patterns and/or creating new combinations of subpatterns. Thus distributed multi-agent systems can spontaneously exhibit adaptive global behaviors in the same sense, and by the same mechanism, as with the organizational principles familiar in connectionist models of organismic learning.

    Title Reduction of Total Lung Capacity in Obese Men: Comparison of Total Intrathoracic and Gas Volumes.
    Date October 2010
    Journal Journal of Applied Physiology (bethesda, Md. : 1985)
    Excerpt

    Restriction of total lung capacity (TLC) is found in some obese subjects, but the mechanism is unclear. Two hypotheses are as follows: 1) increased abdominal volume prevents full descent of the diaphragm; and 2) increased intrathoracic fat reduces space for full lung expansion. We have measured total intrathoracic volume at full inflation using magnetic resonance imaging (MRI) in 14 asymptomatic obese men [mean age 52 yr, body mass index (BMI) 35-45 kg/m2] and 7 control men (mean age 50 yr, BMI 22-27 kg/m2). MRI volumes were compared with gas volumes at TLC. All measurements were made with subjects supine. Obese men had smaller functional residual capacity (FRC) and FRC-to-TLC ratio than control men. There was a 12% predicted difference in mean TLC between obese (84% predicted) and control men (96% predicted). In contrast, differences in total intrathoracic volume (MRI) at full inflation were only 4% predicted TLC (obese 116% predicted TLC, control 120% predicted TLC), because mediastinal volume was larger in obese than in control [heart and major vessels (obese 1.10 liter, control 0.87 liter, P=0.016) and intrathoracic fat (obese 0.68 liter, control 0.23 liter, P<0.0001)]. As a consequence of increased mediastinal volume, intrathoracic volume at FRC in obese men was considerably larger than indicated by the gas volume at FRC. The difference in gas volume at TLC between the six obese men with restriction, TLC<80% predicted (OR), and the eight obese men with TLC>80% predicted (ON) was 26% predicted TLC. Mediastinal volume was similar in OR (1.84 liter) and ON (1.73 liter), but total intrathoracic volume was 19% predicted TLC smaller in OR than in ON. We conclude that the major factor restricting TLC in some obese men was reduced thoracic expansion at full inflation.

    Title Bladder Cancer in Native Americans and Alaskan Natives.
    Date August 2008
    Journal Urology
    Excerpt

    OBJECTIVES: The prevalence of bladder cancer among Native Americans/Alaskan Natives (NAs/ANs) is generally considered to be low. However, the relative morbidity and mortality seem high. We have undertaken this survey of the published data to explore and document this observation. METHODS: An extensive survey of the published data was undertaken. The Surveillance, Epidemiology and End Results data in particular were assessed. RESULTS: The incidence of bladder cancer among the NA/AN peoples is inexplicably low. This low incidence is more remarkable, given the widespread use of tobacco products and the disproportionately high incidence of kidney cancer in this same population. Despite this low incidence, NA/AN men and women seem to be at a relatively greater risk of dying of bladder cancer, once it has been diagnosed. CONCLUSIONS: More and larger studies are needed to clarify and update the incidence, cell type, and clinical outcomes of bladder cancer among NA/AN men and women. Social, economic, and political barriers to treatment also need to be addressed. Effective steps need to be undertaken to ensure more timely diagnosis and treatment of this disease.

    Title Exploratory Factor Analysis: Strategies Used by Patients to Promote Health.
    Date August 2007
    Journal World Journal of Urology
    Excerpt

    Strategies used by patients to promote health (SUPPH) was used to measure self-care self-efficacy in patients with cancer. The objectives of this study were (1) to determine the extent to which self-efficacy theory explained the factor structure of the SUPPH and (2) to determine the relationship of demographic data with factors of the SUPPH. Subjects were diagnosed with prostate cancer (PCa) and treated with either: (a) radical prostatectomy, (b) intensity modulated radiation therapy (IMRT) + radioactive seed implantation, or (c) IMRT + high dose rate. Subjects completed a demographic questionnaire and the SUPPH. Exploratory factor analysis of the SUPPH was performed using a varimax rotation. Subjects (n = 265) were predominately white and averaged 68 years of age. The model explained 81.3% of the total sum of eigenvalues. Two factors of the SUPPH were identified: physiological efficacy information and performance efficacy information. Younger subjects who were fully employed and earning more money had significantly higher performance self-efficacy than older subjects who were working part time and earning less money. Results are congruent with Bandura's (1997) description of self-efficacy. Use of the SUPPH may facilitate research validating Bandura's (1997) assertion that an individual's self-efficacy is related to quality of life (QOL) during chronic illness. Additional research focusing on self-efficacy and PCa patients' QOL may lead to efficacy enhancing interventions that will improve QOL of patients with PCa.

    Title Syringocele of Cowper's Gland Duct: an Increasingly Common Rarity.
    Date July 2007
    Journal The Journal of Urology
    Title Multiphasic Helical Ct Criteria for Differentiation of Recurrent Neoplasm and Desmoplastic Reaction After Laparoscopic Resection of Renal Mass Lesions.
    Date July 2004
    Journal Journal of Endourology / Endourological Society
    Excerpt

    BACKGROUND AND PURPOSE: Differentiation of recurrent neoplasm and desmoplastic reaction following laparoscopic resection of renal mass lesions poses a problem. The usefulness of multiphasic helical CT-generated criteria based on enhancement and morphologic characteristics was investigated. PATIENTS AND METHODS: The findings in 5 female and 12 male patients aged 29 to 68 years having renal-cell carcinoma (11-38 mm; N = 15) or solitary angiomyolipomas (N = 2) treated by laparoscopic resection (N = 15) or open segmental surgery (N = 2) were analyzed. Multiphasic helical CT was performed in the preenhancement, arterial corticomedullary, parenchymal, and excretory phases generating 2.5- to 7-mm slices. RESULTS: Both recurrent neoplasms showed median postcontrast enhancement of 119 HU in the arterial corticomedullary phase; the median enhancement of desmoplastic masses was 48 HU. In the parenchymal and excretory phase, recurrent neoplasms showed progressive loss of enhancement, whereas desmoplastic lesions sustained enhancement at about the same level. Recurrent neoplasms presented a defined mass with characteristic spiculation, whereas desmoplastic reaction was characterized by an ill-defined mass with spidery projections extending to abutting fat and residual fascial planes. On 2- to 3-month follow-up scans, recurrent neoplasms showed progressive increases in size and desmoplastic reaction a sharp decrease. CONCLUSION: Enhancement of the mass at the operative site on arterial corticomedullary-phase CT to >90 HU strongly suggests recurrent renal-cell carcinoma, while progressive decrease in size on 1- to 3-month follow-up CT suggests a desmoplastic reaction.

    Title Multiphasic Helical Ct Diagnosis of Early Medullary and Papillary Necrosis.
    Date June 2004
    Journal Journal of Endourology / Endourological Society
    Excerpt

    PURPOSE: The feasibility of identifying early manifestations of renal papillary necrosis (RPN) and medullary necrosis (RMN) on multiphasic helical CT, leading to prompt treatment for the causative conditions, and its impact on reducing the incidence of late-stage RML and RPN, was investigated. PATIENTS AND METHODS: Sixty-eight patients (35 male, 33 female) aged 19 to 88 years were examined by multiphasic helical CT for complaints of microscopic hematuria (N=49), macroscopic hematuria (N=2), bacteriuria (N=45), pyuria (N=10), fever (N=15), and flank pain (N=27). Preenhancement, arterial corticomedullary, parenchymal, and excretory phase scans generated 1.25 to 7-mm-thick slices. Follow-up CTs were performed at 1 month (N=62) and 3 months (N=58). RESULTS: While the attenuation coefficients of areas suspect for RMN and RPN were similar on preenhancement CT, they differed substantially on the arterial corticomedullary phase (lesions 55 HU mean; normal medulla 120 HU mean) and parenchymal phase (lesions 58 HU mean, normal medulla 210 HU mean). Investigation for predisposing conditions identified diabetes in 18 patients, upper urinary-tract infections in 48, sickle-cell disease or trait in 17, urinary obstruction in 7, and cirrhosis of the liver in 1. On follow-up examinations, enhancement had normalized in 26 compromised areas of 14 patients at 1 month, and 47 areas (23 patients) at 3 months, remained stationary in 28 patients at 1 month and 9 at 3 months, and progressed in 20 at 1 and 26 at 3 months (P<0.001; Fisher's exact test). Patients (N=35) treated for underlying conditions causing ischemia showed reperfusion in 12 cases at 1 month and 20 at 3 months, while of the untreated patients (N=10), none showed reperfusion, and all lesions increased in size. CONCLUSIONS: Multiphasic helical CT is recommended for identification of RMN and RPN at a stage when effective treatment of underlying causative conditions can arrest or reverse the process of devascularization and prevent loss of medullary tissue.

    Title Evaluation of the Incidentally Discovered Adrenal Mass.
    Date April 2004
    Journal Current Urology Reports
    Excerpt

    The increased use of abdominal ultrasonography, computed tomography, and magnetic resonance imaging has led to the classification of adrenal lesions termed the incidentally identified adrenal mass or adrenal incidentaloma. Unlike for the large, clinically, or biochemically symptomatic adrenal mass, the evaluation of patients with small, asymptomatic, or nonfunctional adrenal lesions remains controversial. The evaluation of these adrenal incidentalomas presents a challenge to endocrinologists, radiologists, and urologic surgeons alike. A multidisciplinary approach with biochemical screening and radiologic evaluation is essential to assess the nature and function of these lesions. Furthermore, it is of great importance to identify patients who are morbidly affected by hormonal hypersecretion or malignant potential. This article describes the emerging guidelines for the evaluation of the incidental adrenal mass.

    Title "indeterminate" Cystic Lesion of the Kidney Partially Lined by Small Cells with Clear Cytoplasm--malignant or Benign?
    Date July 2003
    Journal Urology
    Excerpt

    Complex renal cysts, which present radiographically as "indeterminate for malignancy" (Bosniak category III), can prove challenging both pathologically and clinically. We report a case of a renal cyst that, by standard radiographic and histologic criteria, should have been diagnosed as a malignant cystic renal cell carcinoma. However, the cytogenetic profile appeared more closely consistent with cystic renal adenoma or low-grade papillary renal cell carcinoma--tumors with limited metastatic potential. We postulate that other, similarly complex, renal cysts might also be more precisely defined by meticulous histopathologic examination, supported by cytogenetic study.

    Title Detection of Medullary and Papillary Necrosis at an Early Stage by Multiphasic Helical Computerized Tomography.
    Date July 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Multiphasic helical computerized tomography (CT) is advocated to identify early manifestations of papillary and medullary necrosis based on decreased enhancement of circumscribed areas in the medullary pyramid. At this stage the devascularizing process can be reversed if causative conditions such as infections or diabetes mellitus are effectively treated. MATERIALS AND METHODS: Multiphasic helical CTs were performed in 31 male and 26 female patients with complaints of microscopic hematuria (41), macroscopic hematuria (2), bacteriuria (39) and pyuria (9). Pre-enhancement, arterial, early corticomedullary, parenchymal and excretory phase helical CTs generated 1.25 to 5 mm. thick slices. Followup examination included multiphasic helical CT at 1 and 3 months, and excretory urography for some patients at 3 months. RESULTS: Bacteriuria was identified as the probable cause of medullary and papillary necrosis in 39 patients, of whom 28 were treated with effective antibiotic therapy, resulting in normalization and re-perfusion of the initial lesion in 16, no change in 5 and progressive disease in 7 at 3-month followup. Of 8 lesions not treated with specific antibiotic therapy 4 progressed and 4 remained unchanged. CONCLUSIONS: Multiphasic helical CT unlike the excretory urogram can identify medullary and papillary necrosis at an early stage when effective treatment of the underlying cause can reverse the process of devascularization and prevent sloughing of medullary tissues.

    Title Improved Detection of Renal Pathologic Features on Multiphasic Helical Ct Compared with Ivu in Patients Presenting with Microscopic Hematuria.
    Date June 2003
    Journal Urology
    Excerpt

    OBJECTIVES: To examine the virtues of multiphasic helical computed tomography (CT) in the diagnosis of upper urinary tract lesions refractory to identification by intravenous urography (IVU). METHODS: A total of 86 patients (59 men and 27 women), 27 to 88 years old, with microscopic hematuria and negative IVU findings were examined with multiphasic helical CT consisting of a pre-enhancement, late arterial-early cortical-medullary, nephrographic, and excretory phase helical CT of the kidneys, using 3 to 5-mm collimation and 7.5-mm/s table feed. RESULTS: The multiphasic helical CT was conclusive in 84 lesions. Twenty-five cases of early papillary and medullary necrosis, 7 of 8 inflammatory lesions, 3 caliceal diverticula, 1 lupus nephritis, 26 small calculi, 2 medullary sponge kidney, 5 vascular anomalies, and 3 infarcts presented with characteristic manifestations on CT but lacked findings on IVU. Similarly 8 of 9 small malignant neoplasms, 2 small benign neoplasms, and 2 small cysts produced no detectable findings on IVU but were readily diagnosed on helical CT. CONCLUSIONS: Characteristic findings, particularly on late arterial, early corticomedullary, parenchymal, and excretory phase helical CT make possible the diagnosis of early inflammatory disease, small masses and neoplastic lesions, and vascular abnormalities. Limited resolution (needed to identify small calculi) and the lack of ability to capture phases significantly reduce the diagnostic ability of IVU.

    Title Ct-guided Biopsy of Indeterminate Renal Cystic Masses (bosniak 3 and 2f): Accuracy and Impact on Clinical Management.
    Date February 2003
    Journal European Radiology
    Excerpt

    The purpose of this study was to determine ability of cyst aspiration and core biopsy to differentiate malignancies, and benign lesions needing intervention from benign complex cysts in the group of Bosniak 2F and 3 renal cysts. One hundred ninety-nine indeterminate complex renal cysts were biopsied under CT or US guidance using a coaxial system (19-G sheath, 20- or 21-G Chiba or Franseen or 18-G spring biopsy needle). Cytology, amylase, lipase, LDH, fat, protein, urea nitrogen, creatine, and culture and sensitivity were assessed in all patients, histopathology in 116, and flow cytometry in 32. In 179 patients (87.9%) a definitive diagnosis was made; in 20 the specimen was inadequate. Twenty of 28 malignancies were correctly diagnosed (sensitivity 0.71); 27 of 31 benign lesions needing intervention (sensitivity 0.87) and 128 of 140 benign complex cysts (sensitivity 0.91). All inconclusive biopsies were explored revealing six malignancies. There were four CT biopsy misdiagnoses: two renal cell carcinomas; one angiomyolipoma; and one abscess. Guided cyst puncture aspiration and core biopsy significantly altered management of Bosniak 3 and 2F renal cysts obviating surgery or invasive procedures in 70% of the patients with an affirmed diagnosis of benign complex cyst and rendering timely surgical and other interventions in the remaining patients. Long-term follow-up (mean 5.6 years) revealed no further misdiagnosis.

    Title Il-6 Signaling by Stat3 Participates in the Change from Hyperplasia to Neoplasia in Nrp-152 and Nrp-154 Rat Prostatic Epithelial Cells.
    Date November 2002
    Journal Bmc Cancer
    Excerpt

    STAT3 phosphorylation is associated with the neoplastic state in many types of cancer, including prostate cancer. We investigated the role of IL-6 signaling and phosphorylation of STAT3 in 2 rat prostatic epithelial lines. NRP-152 and NRP-154 cells were derived from the same rat prostate, yet the NRP-152 cells are not tumorigenic while the NRP-154 cells are tumorigenic. These lines are believed to represent 2 of the stages in the development of prostate cancer, hyperplasia and neoplasia. Differences in signaling pathways should play a role in the 2 phenotypes, hyperplastic and neoplastic.

    Title Computerized Tomography Tailored for the Assessment of Microscopic Hematuria.
    Date January 2002
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We report the results of a multicenter study of arterial, corticomedullary, nephrographic and excretory phase helical computerized tomography (CT) for detecting and characterizing abnormalities causing asymptomatic microscopic hematuria. MATERIALS AND METHODS: We evaluated 350 consecutive patients, including 216 men and 134 women 23 to 88 years old, with asymptomatic microscopic hematuria of undetermined cause at 4 medical centers. Patients with known urological pathology were excluded from study. We performed 4 helical CT sequences, including pre-enhancement phase imaging from kidney to symphysis pubis, arterial phase imaging of the kidney and lower pelvis, corticomedullary nephrographic phase imaging of the kidney and lower pelvis, and excretory phase imaging from kidney to symphysis pubis with 2 to 5 mm. collimation and 1 to 1.5 pitch. RESULTS: Of 171 proved lesions 158 were correctly diagnosed. There were 10 false-positive and 13 false-negative diagnoses, indicating 0.9239 sensitivity, 0.9441 specificity, 0.9404 positive and 0.9285 negative predictive values, (p <0.001). All cases of congenital renal lesions, calculous disease, ureteral lesion and neoplastic lesion of the bladder were correctly diagnosed, as were 40 of 41 inflammatory renal, 21 of 23 renal masses and 13 of 16 inflammatory bladder lesions. In 27 patients with renal calculi the study was limited to pre-enhancement spiral CT. CONCLUSIONS: A positive diagnosis rate of 45.1% (158 of 350 cases) for the causes of heretofore refractory cases of hematuria with high sensitivity and specificity attest to the effectiveness of our hematuria CT protocol and support its use.

    Title Endourologic Management of Malignant Ureteral Strictures.
    Date January 2001
    Journal Journal of Endourology / Endourological Society
    Excerpt

    PURPOSE: This retrospective analysis assessed the efficacy of balloon dilatation, endoureterotomy, percutaneous ureteroneocystostomy with stenting, and insertion of Wallstents in the management of malignant ureteral strictures with an intact or compromised vascular supply. PATIENTS AND METHODS: A series of 127 patients with ureteral strictures secondary to malignancies were assessed after at least 2-year follow-up (range 2-5 years; mean 3.5 years). Balloon dilation (antegrade approach) was applied in 46 patients, endoureterotomy with temporary stenting in 37, percutaneous ureteroneocystostomy with stenting in 34, bougie and stents in 13, and Wallstents in 31. RESULTS: Balloon dilatation was successful in only two of four malignant midureteral stenoses with intact vascular supplies and was even less successful (10%) in midureteral strictures with a compromised vascular supply. Endoureterotomy failed in all cases to prevent ureteral obstruction. Percutaneous ureteroneocystostomy achieved patency in 11 of 34 patients (33%) having a compromised ureteral vascular supply. Wallstents were successful in 18 of 31 patients (58%) with stenoses of the pelvic ureter. CONCLUSIONS: Percutaneous ureteroneocystostomy with stenting meets the requirement for palliation in patients with obstruction secondary to pelvic neoplasms. Wallstents proved to be most successful when used in the pelvic ureter.

    Title Endourologic Management of Benign Ureteral Strictures with and Without Compromised Vascular Supply.
    Date May 2000
    Journal Urology
    Excerpt

    OBJECTIVES: To retrospectively assess the efficacy of balloon dilation, endopyelotomy/ureterotomy, and stenting alone in the management of benign ureteral strictures with intact or compromised vascular supply. METHODS: One hundred fourteen patients with benign ureteral strictures were assessed after at least a 2-year follow-up (range 2 to 16 years, mean 6.3). Balloon dilation was performed in 81, endopyelotomy/ureterotomy with temporary stenting in 27, and ureteral stenting alone in 6 patients. Ureteral strictures were divided into strictures with intact or with compromised vascular supply. RESULTS: Balloon dilation was successful in short ureteral strictures with intact vascular supply in 33 of 37 (89.2%), but only in 3 of 8 (37.5%) long ureteral strictures and in 1 of 2 (50%) recurrent ureteropelvic junction strictures. Balloon dilation was less successful when the vascular supply was compromised in 2 (40%) of 5 short strictures, 1 (16.7%) of 6 long strictures, and 2 (33.3%) of 6 recurrent ureteropelvic junction strictures. Endopyelotomy/ureterotomy was successful in 17 (89.5%) of 19 strictures with compromised vascular supply. CONCLUSIONS: Balloon dilation is recommended for management of short strictures with intact vascular supply. Endoureterotomy with stenting is recommended for all long ureteral strictures, for ureteropelvic junction stenoses, and for short ureteral strictures with compromised vascular supply and benign underlying etiology.

    Title Penile Kaposi's Sarcoma Preceded by Chronic Penile Lymphoedema.
    Date May 2000
    Journal The British Journal of Dermatology
    Excerpt

    Kaposi's sarcoma localized to the penis with striking lymphoedema is extraordinary. We report a middle-aged Haitian man who was human herpesvirus-8 seropositive, without evidence of immunosuppression or human immunodeficiency virus infection. He was first seen with Kaposi's sarcoma of 6 months duration localized to his penis, preceded by a 3-year history of chronic penile lymphoedema. His tumour regressed completely after radiotherapy. We propose that chronic lymphoedema in this patient predisposed to the development of Kaposi's sarcoma.

    Title Accuracy of Diagnosis by Guided Biopsy of Renal Mass Lesions Classified Indeterminate by Imaging Studies.
    Date March 2000
    Journal Urology
    Excerpt

    OBJECTIVES: To define the accuracy, safety, and impact of percutaneous biopsies of indeterminate mass lesions as an additional diagnostic tool. The vast majority of renal mass lesions are routinely diagnosed by radiographic features alone. However, with the increased use of computed tomography scanning and ultrasound, many smaller renal masses, which are "indeterminate" (refractory to categorization on the basis of imaging alone), are now being discovered. METHODS: We retrospectively reviewed 583 patients (364 male and 219 female) with indeterminate renal mass lesions diagnosed by imaging studies that were further investigated by percutaneous biopsy. Patients were followed up for at least 5 years if the biopsy result demonstrated a benign lesion, or they underwent surgical exploration if the biopsy result demonstrated a malignancy. Biopsy or aspiration material was assessed by histopathologic and cytologic evaluation and, when appropriate, with biochemistry, Gram stain, culture, and sensitivity. The biopsy site was localized by computed tomography, ultrasound, or fluoroscopy. RESULTS: Five hundred eighty-three patients with indeterminate renal mass lesions (representing 7.2% of all renal masses diagnosed from 1967 through 1996) were diagnosed by imaging studies complemented by guided biopsy. Sixty-six patients were lost to follow-up, leaving 517 patients who were analyzed. In 393 cases (76%), the imaging-guided biopsy provided a definitive diagnosis. The incidence of false diagnoses was 1.2% (7 biopsies). In 124 of the cases (21%), imaging-guided biopsy was unable to determine the etiology of the lesion with acceptable confidence; of these, 21 biopsies did not provide enough material to establish the diagnosis (16.9%). CONCLUSIONS: Overall, percutaneous biopsy of the kidney has proved to be a safe and accurate diagnostic procedure, with impact on the management of cystic or solid renal lesions.

    Title Percutaneous Nephrostomy As Adjunct Management in Advanced Upper Urinary Tract Infection.
    Date September 1999
    Journal Urology
    Excerpt

    OBJECTIVES: To determine by retrospective review of 315 percutaneous nephrostomies, performed for pyonephrosis, whether this intervention has major clinical advantages. METHODS: From 1977 to 1996, under the direct supervision of the senior author of this report (E.K.L.), at seven hospital sites, 315 patients (181 males, 134 females; 17 to 88 years of age) were treated with percutaneous nephrostomy and antibiotic therapy for infected hydronephrosis. RESULTS: Additional or disparate pathogens were identified in 116 (36.8%) of 315 patients, leading to a clinically significant change in, or addition of, antibiotics and/or antifungal agents in 84 (73%) of 116. Most notably, we often found a clinically important disparity between the results of cultures obtained from the nephrostomy and those obtained from bladder-urine specimens. CONCLUSIONS: This retrospective review confirms previously reported advantages of percutaneous upper urinary tract drainage as a potentially life-saving adjunct in the treatment of pyonephrosis. Several case studies highlight the advantage of this maneuver in difficult cases involving obstruction due to extensive fungus or debris. In particular, our review focuses attention on the clinically important insight that urine cultures from percutaneous nephrostomy drainage often identify pathogens that differ from those detected in concurrent bladder cultures.

    Title Placement of Metallic Stents in Ureters Obstructed by Carcinoma of the Cervix to Maintain Renal Function in Patients Undergoing Long-term Chemotherapy.
    Date December 1998
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE: Metallic stents, sometimes augmented by "J" endostents, were placed in ureters obstructed by advanced carcinoma of the cervix to improve or maintain renal function in these patients at a level necessary to pursue long-term chemotherapy and radiation therapy. SUBJECTS AND METHODS: Seventeen ureters in 11 patients were treated with metallic stents, which were placed by an anterograde approach in 10 patients and by a retrograde approach in one. An anterograde ureteroneocystostomy was necessary in two of the 11 patients. J endostents were placed for I month in all patients. In 10 ureters, J endostents were reintroduced during follow-up 1-48 months later. RESULTS: In 17 ureters, metallic stents were successfully placed; in the remaining three ureters, the procedures were aborted because of technical difficulties. The goal of improving and maintaining renal function was met in 10 patients. Serum creatinine levels returned to normal in four patients and stabilized at a range of 2.7-3.2 mg/dl in six more patients, permitting treatment with chemotherapy, radiation therapy, or both. Four of the 11 patients died within 4 months after treatment, and three more died within 2 years. At the time of death or last follow-up, seven metallic stents and eight combinations of metallic stents and J endostents were patent. Complications were minor. CONCLUSION: Placement of metallic stents is recommended as an effective method to ensure patency and to facilitate cystoscopic replacement of J endostents in ureters compromised by carcinoma of the cervix. Renal function can be maintained, allowing chemotherapy. Survival is governed by the effectiveness of chemotherapy and radiation therapy.

    Title Abdominal Compartment Syndrome.
    Date May 1998
    Journal Southern Medical Journal
    Excerpt

    BACKGROUND: The abdominal compartment syndrome (ACS) is a newly appreciated and potentially fatal consequence of increased intra-abdominal pressure. It can be due to either trauma or surgery, as well as numerous medical conditions. Prolonged, unrelieved elevation of intra-abdominal pressure can produce pulmonary compromise, renal impairment, cardiac failure, shock, and death. A high index of suspicion is imperative. Measurement of the intravesical pressure provides a urometric window for detecting and monitoring this condition. CONCLUSIONS: Reopening the abdominal incision (decompressive celiotomy) has proven a life-saving intervention. Use of delayed wound closure (staged celiotomy) may prevent development of this condition in high-risk surgical patients. It is urgent that all physicians, and surgeons in particular, be alerted to this potentially lethal complication.

    Title Incidence of Stool Guaiac Conversion Following Extracorporeal Shock Wave Lithotripsy.
    Date September 1997
    Journal Urology
    Excerpt

    OBJECTIVES: To study, in a prospective fashion, acute traumatic effects on the gastrointestinal tract of patients treated by extracorporeal shock wave lithotripsy (ESWL). METHODS: Stool samples from each of 54 patients were tested before and after ESWL for conversion to hemoccult positive. A minimum of one negative pre-ESWL stool guaiac test was required for inclusion into the study. A minimum of two stool guaiac tests were done after ESWL to verify negativity. Patients who converted to a positive hemoccult test after ESWL were then evaluated by colonoscopy for the source of bleeding. RESULTS: Fifty patients completed the study. A single patient (2.0%) converted to a positive post-ESWL hemoccult test and was evaluated with colonoscopy. This patient was found to have two benign adenomatous polyps in the sigmoid and descending colon after treatment for a left renal pelvis calculus. An additional patient with a slightly positive post-ESWL conversion refused further evaluation. The overall post-ESWL conversion rate to guaiac positive, therefore, was less than 4% (2 of 51 patients). CONCLUSIONS: There is no evidence of significant trauma or detectable bleeding in the normal gastrointestinal tract caused by ESWL as measured by postprocedure stool guaiac testing. Guaiac testing of the stool after ESWL may unmask pre-existing gastrointestinal disease. Therefore a positive guaiac test after ESWL warrants further evaluation. This study reaffirms that ESWL is a safe, minimally invasive technique for the treatment of urolithiasis, without significant adverse side effects on the gastrointestinal tract.

    Title Effects of Posture on Respiratory Mechanics in Obesity.
    Date March 1996
    Journal Journal of Applied Physiology (bethesda, Md. : 1985)
    Excerpt

    Increased abdominal mass in obesity should enhance normal gravitational effects on supine respiratory mechanics. We have examined respiratory impedance (forced oscillation over 4-26 Hz applied at the mouth during tidal breathing), maximum inspiratory and expiratory mouth pressures (MIP and MEP), and maximum effort flow-volume curves seated and supine in seven obese subjects (O) (mean age 51 yr, body mass index 43.6 kg/m2) and seven control subjects (C) (mean age 50 yr, body mass index 21.8 kg/m2). Seated mean total lung capacity was smaller in O than in C (82 vs. 100% of predicted); ratio of functional residual capacity (FRC) to total lung capacity averaged 43% in O and 61% in C (P < 0.01). Total respiratory resistance (Rrs) at 6 Hz seated was higher in O (4.6 cmH2O.l-1.s) than in C (2.2 cmH2O.l-1.s; P < 0.001); total respiratory reactance (Xrs) at 6 Hz was lower in O than in C. In C, on changing to the supine posture, mean Rrs at 6 Hz rose to 2.9 cmH2O.l-1.s, FRC fell by 0.68 liter, and Xrs at 6 Hz showed a small fall. In O, despite no further fall in FRC, supine Rrs at 6 Hz increased to 7.3 cmH2O.l-1.s, and marked frequency dependency of Rrs and falls in Xrs developed. Seated, MIP and MEP in C and O were similar; supine there were small falls in MEP and maximum expiratory flow in O. The site and mechanism of the increase in supine Rrs and reduction in supine Xrs and the mechanism maintaining supine FRC in obesity all need further investigation.

    Title Home Hyperalimentation for Common Variable Hypogammaglobulinemia with Malabsorption Secondary to Intestinal Nodular Lymphoid Hyperplasia.
    Date November 1987
    Journal The American Journal of Gastroenterology
    Excerpt

    Common variable hypogammaglobulinemia (immunodeficiency), a disorder characterized by late-onset immunoglobulin deficiency and lack of humoral immunity, has a variable association with bronchiectasis, cholelithiasis, nodular lymphoid hyperplasia, gastrointestinal neoplasia, megaloblastic anemia, and malabsorption. The patient described in this report had all of the above except neoplasia. In addition, he had calcium oxalate renal stones probably secondary to his malabsorption. The first case demonstrating the beneficial effect of home hyperalimentation in patients with severe malabsorption refractory to other treatments is described. Home hyperalimentation overnight allows the patient freedom for daily activities while also being more cost-effective than in-hospital parenteral nutrition.

    Title Acquired Immunodeficiency Syndrome in Arkansas.
    Date November 1986
    Journal The Journal of the Arkansas Medical Society
    Title Allergic Reaction to Protamine: a Late Complication of Elective Vasectomy?
    Date January 1984
    Journal Urology
    Excerpt

    Nucleoprotamines are a normal component of human sperm cells. Antibodies against these protamines develop in 22 to 33 per cent of patients undergoing elective vasectomy. These antibodies, in turn, have been shown to cross-react with medicinal protamines, which are extracted commercially from the testes of salmon and certain other fish. This cross-reactivity against protamines raises the possibility that patients who have undergone elective vasectomy may be at increased risk of an allergic reaction developing if they are later exposed to protamine as a medication. Since medicinal protamines currently enjoy widespread clinical use, this information should be borne in mind by those clinician using protamine and by urologists when counselling patients concerning elective vasectomy for sterilization.

    Title Anatomy and Pathology of the Male Pelvis by Magnetic Resonance Imaging.
    Date January 1984
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    Magnetic resonance imaging (MRI) of the male pelvis was performed in 25 subjects: five normal volunteers; six patients with carcinoma of the bladder; nine with benign nodular hyperplasia (including five with concomitant bladder carcinoma); nine with prostatic carcinoma; and one with a lymphocele after radical prostatectomy. The display of normal anatomy is enhanced by the ability of the MRI device to provide images in direct transverse, sagittal, and coronal planes. Sessile and pedunculated types of bladder carcinoma are readily shown due to the superior ability of MRI for soft-tissue characterization. Direct sagittal scans are advantageous for evaluation of tumors at the bladder base, and by combining two different planes of images, the extent of the neoplasm is better delineated. In the analysis of the prostate, MRI displays the gland in three dimensions and therefore allows accurate volumetric measurements. The greatest potential of MRI seems to be its ability to detect pathology confined to the gland. However, it is not yet known if a neoplastic nodule can be differentiated from chronic prostatitis. Unlike x-ray CT, metallic clips produce no streaking artifacts, giving MRI a definite advantage in the evaluation of patients after radical surgery. These observations were made on a small number of patients. If the results are confirmed with a larger number of patients, MRI will assume a prominent role in the clinical evaluation of bladder and prostate cancer.

    Title Computed Tomographic Demonstration of Ureterosciatic Hernia.
    Date September 1983
    Journal Ajr. American Journal of Roentgenology
    Title Fractured Catheter: Unusual Complication of Percutaneous Nephrostomy.
    Date July 1983
    Journal Urology
    Title The Value of Computerized Tomography in Evaluation of Pelvic Lymph Nodes.
    Date September 1981
    Journal The Journal of Urology
    Title Perivesical Mass and Vertical Bladder Caused by Massive Prostatic Enlargement.
    Date April 1980
    Journal Urology
    Excerpt

    Massive prostatic enlargment may present with the radiographic appearance of a perivesical mass and pear-shaped bladder. An explanation of this appearance, based on the compouted tomographic findings, is offered. We discuss the differential diagnosis.

    Title Psychopathology and Perception of Physiques.
    Date August 1971
    Journal Perceptual and Motor Skills
    Title Cross-correlation of Tenerife Data with Galactic Templates-evidence for Spinning Dust?
    Date
    Journal The Astrophysical Journal
    Excerpt

    The recent discovery of dust-correlated diffuse microwave emission has prompted two rival explanations: free-free emission and spinning dust grains. We present new detections of this component at 10 and 15 GHz by the switched-beam Tenerife experiment. The data show a turnover in the spectrum and thereby support the spinning dust hypothesis. We also present a significant detection of synchrotron radiation at 10 GHz, which is useful for normalizing foreground contamination of cosmic microwave background experiments at high galactic latitudes.

    Title Relation Between Trunk Fat Volume and Reduction of Total Lung Capacity in Obese Men.
    Date
    Journal Journal of Applied Physiology (bethesda, Md. : 1985)
    Excerpt

    Reduction in total lung capacity (TLC) in obese men is associated with restricted expansion of the thoracic cavity at full inflation. We hypothesized that thoracic expansion was reduced by the load imposed by increased total trunk fat volume or its distribution. Using MRI, we measured internal and subcutaneous trunk fat and total abdominal and thoracic volumes at full inflation in 14 obese men [mean age: 52.4 yr, body mass index (BMI): 38.8 (range: 36-44) kg/m(2)] and 7 control men [mean age: 50.1 yr, BMI: 25.0 (range: 22-27.5) kg/m(2)]. TLC was measured by multibreath helium dilution and was restricted (<80% of the predicted value) in six obese men (the OR subgroup). All measurements were made with subjects in the supine position. Mean total trunk fat volume was 16.65 (range: 12.6-21.8) liters in obese men and 6.98 (range: 3.0-10.8) liters in control men. Anthropometry and mean total trunk fat volumes were similar in OR men and obese men without restriction (the ON subgroup). Mean total intraabdominal volume was 9.41 liters in OR men and 11.15 liters in ON men. In obese men, reduced thoracic expansion at full inflation and restriction of TLC were not inversely related to a large volume of 1) intra-abdominal or total abdominal fat, 2) subcutaneous fat volume around the thorax, or 3) total trunk fat volume. In addition, trunk fat volumes in obese men were not inversely related to gas volume or estimated intrathoracic volume at supine functional residual capacity. In conclusion, this study failed to support the hypotheses that restriction of TLC or impaired expansion of the thorax at full inflation in middle-aged obese men was simply a consequence of a large abdominal volume or total trunk fat volume or its distribution.


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