Discovery of Metabolic Biomarkers Predicting Radiation Therapy Late Effects in Prostate Cancer Patients.

Patients presenting with prostate cancers undergo clinical staging evaluations to determine the extent of disease to guide therapeutic recommendations. Management options may include watchful waiting, surgery, or radiation therapy. Thus, initial risk stratification of prostate cancer patients is important for achieving optimal therapeutic results or cancer cure and preservation of quality of life.

Accountable care organization readiness and academic medical centers.

As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level.

Correlation of HOXD3 promoter hypermethylation with clinical and pathologic features in screening prostate biopsies.

Background: Molecular markers that can discriminate indolent cancers from aggressive ones may improve the management of prostate cancer and minimize unnecessary treatment.Aberrant DNA methylation is a common epigenetic event in cancers and HOXD3 promoter hypermethylation (H3PH) has been found in prostate cancer. Our objective was to evaluate the relationship between H3PH and clinicopathologic features in screening prostate biopsies.

Potency preservation following stereotactic body radiation therapy for prostate cancer.

Background: Erectile dysfunction after prostate radiation therapy remains an ongoing challenge and critical quality of life issue. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT impotency would be higher than conventional radiation therapy approaches. This study sought to evaluate potency preservation and sexual function following SBRT for prostate cancer.

Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience.

Background: Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation which may be radiobiologically favorable to conventional low-dose fractions commonly used for prostate cancer radiotherapy. We report our early experience using SBRT for localized prostate cancer.

Methods: Patients treated with SBRT from June 2008 to May 2010 at Georgetown University Hospital for localized prostate carcinoma, with or without the use of androgen deprivation therapy (ADT), were included in this retrospective review of data that was prospectively collected in an institutional database.

Low incidence of new biochemical and clinical hypogonadism following hypofractionated stereotactic body radiation therapy (SBRT) monotherapy for low- to intermediate-risk prostate cancer.

Background: The CyberKnife is an appealing delivery system for hypofractionated stereotactic body radiation therapy (SBRT) because of its ability to deliver highly conformal radiation therapy to moving targets. This conformity is achieved via 100s of non-coplanar radiation beams, which could potentially increase transitory testicular irradiation and result in post-therapy hypogonadism. We report on our early experience with CyberKnife SBRT for low- to intermediate-risk prostate cancer patients and assess the rate of inducing biochemical and clinical hypogonadism.

Alternative management of complex renal stones.

Introduction: The gold standard for treatment of large and complex renal stones is percutaneous nephrolithotomy (PCNL). However, in patients with significant comorbididties, this option may be suboptimal. We reviewed our experiences with ureterorenoscopy and Holmium laser lithotripsy (UL) for the primary management of large and complex intrarenal calculi.

A pilot study of intensity modulated radiation therapy with hypofractionated stereotactic body radiation therapy (SBRT) boost in the treatment of intermediate- to high-risk prostate cancer.

Clinical data suggest that large radiation fractions are biologically superior to smaller fraction sizes in prostate cancer radiotherapy. The CyberKnife is an appealing delivery system for hypofractionated radiosurgery due to its ability to deliver highly conformal radiation and to track and adjust for prostate motion in real-time. We report our early experience using the CyberKnife to deliver a hypofractionated stereotactic body radiation therapy (SBRT) boost to patients with intermediate- to high-risk prostate cancer.

Urinalysis: a comprehensive review.

A complete urinalysis includes physical, chemical, and microscopic examinations. Midstream clean collection is acceptable in most situations, but the specimen should be examined within two hours of collection. Cloudy urine often is a result of precipitated phosphate crystals in alkaline urine, but pyuria also can be the cause.

Nonvisualization of intravenous methylene blue in patients with clinically normal renal function.

Urologists use intravenous dyes in diagnosing genitourinary fistulas and in investigating ureteral patency. Methylene blue and indigo carmine are the most common dyes used today. Generally, patients with clinically normal renal function demonstrate dye in their urine after several minutes.

A telemedicine consultative service for the evaluation of patients with urolithiasis.

Objectives: A 6-month pilot teleconsultative project linking Georgetown University Medical Center (GUMC) in Washington, DC, and City Hospital in Martinsburg, West Virginia, 90 miles away, was designed to assess the effectiveness of telemedicine on the clinical decision-making process for patients with urolithiasis.

Methods: The telemedicine system designed and tested for this project was based on a PC-based platform. Videoconferencing and review of the patient's imaging studies were performed over an Integrated Service Digital Network (ISDN) with 3 Basic Rate (BRI) ISDN lines providing a 336-kilobytes/s bandwidth through an Inverse Multiplexor (IMUX).

Requirements for urology and renal dialysis PC-based telemedicine applications: comparative analysis.

The Imaging Science and Information Systems (ISIS) Center of the Department of Radiology at Georgetown University Medical Center (GUMC) has been developing technical requirements for different telemedicine applications. This paper details the process through which those technical requirements are determined and shows how they may differ substantially, depending on the clinical need. This information is presented in light of two telemedicine applications being undertaken at GUMC: a urology application for the management of patients with surgical stone disease and a nephrology application for monitoring of renal dialysis patients.

Radiation risk to the urologist during endourologic procedures, and a new shield that reduces exposure.

Objectives: With the increasing use of endourologic procedures to diagnose and treat urologic problems, the urologist's exposure to radiation from fluoroscopy becomes an important safety consideration. Although collimation of the x-ray beam generally prevents direct radiation exposure by the urologist, the patient absorbs radiation during the procedure and becomes a secondary source of exposure through radiation scatter.

Methods: We measured radiation exposure to the urologist during endourologic procedures using standard body shields and thyroid collars.

A modification of standard percutaneous nephrolithotripsy technique for the morbidly obese patient.

Objectives: Urolithiasis in the morbidly obese patient presents several unique challenges to the urologist, and its treatment often requires creativity and innovation. We present a new modification of standard percutaneous nephrolithotripsy (PNL) technique, which is very helpful in overcoming some of the problems that are encountered when performing PNL in this group of patients.

Methods: We present 5 patients in whom this new technique has been used.

Technical tip: use of open-ended guidewire to facilitate laser lithotripsy during flexible ureteroscopy.

You have just passed your flexible ureteroscope to the level of the upper-ureteral calculus. The stone is in view, but as you advance the laser fiber, it fails to exit the ureteroscope. All measures to advance the fiber prove futile.

Safety and effectiveness of Lithostar shock tube C in the treatment of urinary calculi.

Over 14 years of clinical use of extracorporeal shockwave lithotripsy (SWL), great technical modifications resulted in the development of many second-generation lipthotripters. The Siemens Lithostar machine, with its standard shockwave tube, was introduced in 1986. The objective of this study was to assess the safety and effectiveness of the newly proposed Lithostar shock tube C in the treatment of urinary calculi.

The effects of a soft tissue mimicking medium and increased power settings on the location and magnitude of lithotripter peak positive pressure.

In vitro experiments showed that a tissue mimicking medium alters the peak positive pressure (p+), focal zone properties and frequency content of shockwaves compared with their behavior in water. The reduction in (p+) ranged from 5% at 10 kV. to 19% at 18.

Primary hyperparathyroidism in patients with renal stones.

There has been an observed decline in the incidence of renal stones in patients with primary hyperparathyroidism. Some believe that this is related to earlier surgical intervention. Two studies from the 1950s examined the reverse questions to determine the prevalence of primary hyperparathyroidism in patients with renal stones.

Rhabdomyolysis: need for high index of suspicion.

Rhabdomyolysis, both traumatic and nontraumatic, may be defined as a triad of skeletal muscle injury, pigmented urine, and acute renal failure. Nontraumatic rhabdomyolysis may be more of a subtle diagnosis and requires a high index of suspicion. Pertinent findings in the history as well as clinical evidence of muscle injury with a marked elevation of creatinine kinase will suggest the diagnosis.

Renal calculi after shock wave lithotripsy: US evaluation with an in vitro phantom.

Fragments of renal calculi from patients who had undergone extracorporeal shock wave lithotripsy (ESWL) were embedded in an in vitro tissue-equivalent ultrasound (US) phantom to assess (a) the accuracy with which such fragments could be measured; (b) the influence of stone composition, stone depth, and transducer frequency; and (c) the effect of fragment "clumping" on size determinations and acoustic shadowing. Fragments as small as 0.8 mm in diameter could be detected at 7.

Ureteral stricture: experience with 31 cases.

We reviewed the records of 31 patients treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureteroenteral anastomoses (23 per cent), open ureterolithotomy (19 per cent), ureteroscopy (19 per cent), other urological procedures (16 per cent), general surgical and gynecological procedures (13 per cent) and miscellaneous causes (7 per cent). Of the patients 24 were managed initially with antegrade or retrograde balloon dilation or stenting and favorable outcomes were achieved in 12 (50 per cent), with a mean followup of 13 months.