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Biomedical subjects

A W Middleton

Publications and source records attributed to A W Middleton.

At least 19 recordsLinked to original sources
PubMed1997

Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institutional pooled analysis.

OBJECTIVE: We investigated the disease-specific and metastasis-free survival rates in men with locally advanced (clinical stage T3) prostate cancer who were treated surgically. METHODS: A retrospective, multi-institutional pooled analysis of the results of surgical treatment in 345 men with clinical stage T3 disease was performed. Survival curves were generated using the Kaplan-Meier method. RESULTS: Among 298 evaluable patients, pelvic lymphadenectomy alone was performed in 56 men (19%), while 242 men (81%) underwent node dissection and radical prostatectomy. In total, 122 of 298 patients (41%) had nodal metastases and/or seminal vesicle tumor spread. Pathologically organ-confined disease was noted in 27 men (9%). The actuarial 10-year disease-specific and metastasis-free survival rates for all patients managed surgically were 57 and 32%, respectively. For patients with well, moderately and poorly differentiated tumors, cancer-specific survival rates at 10 years were 73, 67 and 29%, respectively. CONCLUSIONS: A large number of men with clinical stage T3 prostate cancer have advanced disease and are unlikely to achieve improved long-term survival with surgery alone. Although there may be a role for radical prostatectomy in selected patients with low to intermediate grade tumors, such treatment appears unlikely to result in long-term survival in men with high grade disease. A prospective study is necessary to determine the optimal treatment approach in men with locally advanced prostate cancer.

Adult↗
PubMed1996

Results of radical prostatectomy in men with clinically localized prostate cancer.

OBJECTIVE: To assess the results of radical prostatectomy in men with early prostate cancer. DESIGN: Retrospective, nonrandomized, multi-institutional pooled analysis. SETTING: Eight university medical centers in the United States and Europe. PATIENTS: A total of 2758 men with stage Tl and T2 prostatic cancer. MAIN OUTCOME MEASURES: Disease-specific and metastasis-free survival rates. RESULTS: Tumor grade was the most important preoperative factor in determining outcome. Disease-specific survival 10 years following surgery and associated 95% confidence intervals were 94% (range, 87%-98%), 80% (range, 74%-85%), and 77% (range, 65%-86%) for those men with grade 1, 2, and 3 tumors, respectively. Metastasis-free survival at 10 years was 87% (range, 78%-92%), 68% (range, 62%-73%), and 52% (range, 38%-64%) for patients with grade 1, 2, and 3 cancers, respectively. CONCLUSIONS: Radical prostatectomy leads to high 10-year disease-specific survival rates in men with all tumor grades. However, caution is needed in comparing these results with similar studies of alternative treatment strategies, such as watchful waiting, due to the inherent potential biases in uncontrolled trials. Nevertheless, these results offer the best currently available estimates of 10-year outcome of radical prostatectomy in men with clinically localized prostate cancer and may be useful in counseling patients with early malignancy.

Europe↗
PubMed1992

Duplicated urethra: an anomaly best repaired.

Three cases of urethral duplication are described--two complete and one incomplete. The surgical approaches used in 2 of the 3 cases are described, the third not having come to definitive surgery as yet. In the patient with an incomplete urethral duplication the accessory urethra and associated ventral preputial hood were excised. A repair of the complete duplication was devised in which an end-to-side urethrourethrostomy and penile plastic revision were accomplished. The literature is reviewed and a new classification system for urethral duplication is proposed.

Humans↗
PubMed1989

Outcome of surgery for biliary atresia.

Forty-seven infants (26 male, 21 female) with biliary atresia under- went hepatic portoenterostomy during the 16-year period 1971-87. Twenty-six patients (55%) are alive 1-17 years after surgery, with 21 (45%) being jaundice-free. For children who became jaundice-free, the mean age at surgery was 78 days (range: 34-125 days), compared with 97 days (range: 48-224 days) for those who did not. Of 39 patients operated on at less than 120 days of age, 24 (60%) are alive. All four patients operated on after 125 days of life died. Of 31 patients operated on more than 5 years ago, 12 (39%) have survived, the oldest being 17 years. Ten (32%) have normal serum bilirubin concentrations, have non-active cirrhosis on liver biopsy, have had normal growth and development, and lead normal lives. The oldest two patients suffered variceal haemorrhage in their teenage years. In our recent experience, 11 of 16 patients (69%) have had complete clearing of jaundice, lead normal lives and do not currently require assessment for liver transplantation. It is believed that early referral of children with biliary atresia to experienced surgical units for portoenterostomy will lead to long-term survival, without the need for liver transplantation in a majority of cases. Liver transplantation should be offered in infancy only after failed portoenterostomy, except for patients presenting after 120 days in whom transplantation may be considered primary therapy.

Age Factors↗
PubMed1987

Radical prostatectomy for carcinoma in men more than 69 years old.

Between 1974 and 1986, 193 men with prostatic cancer were treated with bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. Of the 193 patients 65 were 70 years or older (5 were 78 years old). Of the 32 men in this series who underwent a potency-sparing modification of the radical prostatectomy 7 were 70 years or older, the oldest being 77 years. A comparison of the morbidity and mortality of the 65 men in the older group with the 128 men in the group less than 70 years old revealed no significant difference. Long-term followup data demonstrated 57 men in the older age group to be well with no evidence of disease, with 10 in that group well with no evidence of disease greater than 5 years after the radical prostatectomy. We recommend radical prostatectomy for patients with clinically localized prostatic carcinoma whose general health suggests a 10-year or greater probable life expectancy, aside from tumor.

Aged↗
PubMed1985

Gastric tube oesophagoplasty--a long-term assessment.

The first gastric tube oesophagoplasty at the Royal Alexandra Hospital for Children was performed in 1968. Over the next 15 years, until 1982, a total of 46 operations were performed. This represents the largest series of gastric tube oesophagoplasty in children yet reported in the literature. Two techniques have been in use and are compared. The main aim of the paper is to present the long-term results of gastric tube oesophagoplasty. In our 15 years' experience with the gastric tube for oesophageal replacement, we have found it to be a very satisfactory procedure, with a very low mortality and failure rate. The vascularity of the stomach gives rise to less anxiety than with colon. Early postoperative complications are readily identified and treated. There is a higher risk of serious chest complications in bringing the gastric tube through the chest with primary anastomosis in the neck. This also predisposes to diaphragmatic herniation and obstruction, complications not seen when the gastric tube is brought up substernally. The long-term results are very encouraging, with virtually all the children leading active and normal lives. The gastric tube functions satisfactorily with no evidence of the late complications often reported with colonic tubes. There is no significant difference in the long-term results of the two techniques of gastric tube oesophagoplasty used in this hospital.

Adolescent↗
PubMed1984

Watery diarrhoea and a vasoactive intestinal peptide secreting ganglioneuroma.

A case of a 12-month-old child with chronic water diarrhoea, weight loss, abdominal distension, hypokalaemia and hypochlorhydria, which were associated with a vasoactive intestinal peptide secreting ganglioneuroma, is reported. Removal of the tumour led to complete clinical and biochemical recovery. Measurement of vasoactive intestinal peptide levels should be included in the evaluation of chronic diarrhoea after the more common causes have been ruled out.

Adenoma, Islet Cell↗
PubMed1984

Eosinophilic cystitis in children: a self-limited process.

We report a case of eosinophilic cystitis in a 7-year-old boy. Bilateral hydronephrosis and a lesion involving most of the bladder were seen initially. Complete resolution of all symptoms occurred within 3 weeks and the x-ray findings returned to normal in 6 weeks without specific therapy. A review of all reported cases of eosinophilic cystitis in children suggests that, unlike in adults, the disease is self-limited.

Child↗
PubMed1984

Recurrent abdominal pain in children.

Recurrent abdominal pain in the child is a common and difficult problem for practitioners. To resolve whether its origin is organic or psychogenic takes time and patience. Investigation is made more difficult by the fact that parents and doctors are happier if the pain has an organic basis; in the great majority of children it is caused by stress.

Abdomen↗
PubMed1983

Biliary atresia: review of experience with twenty-three patients.

Prior to the Kasai procedure of hepatic porto-enterostomy in 1959, biliary atresia was a bleak chapter in paediatric surgery. It was only after many years, however, that the procedure became widely accepted. During the past 8 years 23 cases of biliary atresia have been treated at the Royal Alexandra Hospital for Children (RAHC). Twenty-one had the noncorrectable type of atresia. Sustained drainage was obtained in ten patients, all of whom had the noncorrectable type anomaly. Nine are still alive, eight having survived more than one year after operation and all are free from jaundice. Cholangitis has been a problem in six of these patients and six have evidence of fibrosis or cirrhosis on subsequent liver biopsy. Two patients have shown improvement in liver histology since operation. Sustained biliary drainage is related to age at operation, the size of biliary ductules at the porta and the subsequent development of cholangitis. Long term prognosis still remains uncertain.

Bile Ducts↗
PubMed1981

Combined modality therapy with conservation of organ function in childhood genitourinary rhabdomyosarcoma.

Recent refinements in the multimodal therapy of childhood genitourinary rhabdomyosarcoma have produced striking improvements in long-term survival rates while still preserving pelvic organ function in the majority of cases. Three illustrative cases of childhood pelvic rhabdomyosarcoma are presented. Chemotherapy and surgical staging are employed in all 3 cases, with 2 of the cases requiring additional local tumor excision and intraurethral radiation for control of residual microscopic tumor. While long-term follow-up has not been achieved, all 3 patients have had their pelvic organs preserved and remain tumor-free in follow-up periods ranging from twelve to twenty-four months after the initial diagnosis.

Child, Preschool↗
PubMed1981

Malignant gonadal stromal tumor: case report and review of the literature.

Of the 80 cases of gonadal stromal tumor reported in the literature 10 were malignant. We herein report another malignant case. The role of chemotherapy and radiation therapy in malignant gonadal stromal tumor has not been defined. While the only sue evidence of malignancy is metastatic disease we recommend that if macroscopic and microscopic examination of the primary tumor suggests malignancy a retroperitoneal node dissection should be performed.

Adolescent↗
PubMed1981

Pelvic lymphadenectomy with modified radical retropubic prostatectomy as a single operation: technique used and results in 50 consecutive cases.

We evaluated 50 consecutive patients in whom bilateral pelvic lymphadenectomy with radical retropubic prostatectomy was done using a modified surgical technique. In 3 patients (6 per cent) vesical neck stenosis developed. Excluding 8 cases early in the series in whom pubectomy also was done the long-term incontinence rate was 2.4 per cent. We conclude that this modified technique without pubectomy is quite satisfactory in the management of patients with clinical stages A to C prostatic carcinoma and the complication rate appears to be less than with traditional surgical approaches.

Aged↗