Search PubMed⌕ Search

Biomedical subjects

A W Ritchie

Publications and source records attributed to A W Ritchie.

At least 37 records · Page 2Linked to original sources
PubMed1990

Antibiotic compared with antiseptic prophylaxis for prostatic surgery.

Two different regimens of cephalosporin antibiotic prophylaxis were compared with antiseptic lubricating jelly to try to prevent infection and complications in 196 men after prostatic surgery. Pre-operative urine was cultured and prostatic chips (170 cases) were also cultured to define the source of any infection. The use of antibiotics was associated with a reduced risk of postoperative bacteriuria. No serious complications occurred, although 1 patient in the antiseptic treated group developed rigors; 79 of 170 patients (46%) had positive prostatic chip cultures, of whom 74 had sterile pre-operative urine. There was no association between the result of chip culture and the presence of a pre-operative catheter. Culture positive patients had an increased risk of post-operative urine infection, although the same organism was found in the prostate and urine in only 36% of cases of post-operative bacteriuria and in 43 (54%) the organism cultured from the prostate was Staphylococcus albus. This study provides further evidence of the benefit of true prophylactic antibiotic therapy for transurethral prostatic surgery and the prostatic chip data suggest that some of the risk is due to pre-operative contamination of the prostate in the absence of per-operative urinary infection or catheterisation.

Aged↗
PubMed1990

Is long distance lithotripsy effective?

The outcome and morbidity of a group of 132 patients living near a lithotriptor was compared with that for a group of 251 patients living at a distance. The two groups were similar in age, stone burden and the need for preliminary procedures. With short follow-up, the main difference between the groups was the overall stone-free rate (20% difference, X2 = 13.5, d.f. = 1, P less than 0.001). This difference was not apparent when patients with residual fragments of 3 mm or less were included and is explained by shorter follow-up in the 'distant' group. After a minimum period of 10 days follow-up there was no significant difference in the stone-free rates. There was no significant difference between the groups in the incidence of complications (18% for the 'local' group versus 19% for the 'distant' group). The stone-free rates and incidence of complications were similarly related to stone burden in both groups. It is concluded that, within certain limitations such as inconvenience of travel, 'long distance, second generation lithotripsy' offers no disadvantage.

Adolescent↗
PubMed1989

Prognostic significance of the DNA content of renal carcinoma.

DNA analysis was performed on fresh frozen samples of the primary tumor in 32 patients with renal carcinoma (13 with apparently localized disease and 19 with metastases at presentation). A comparison of ploidy with staging and standard histologic variables was performed. None of the patients who presented without metastases died of disease during the follow-up period. Eleven of 13 patients of this group had a diploid/near diploid pattern, and metastases developed in only one patient. Patients with metastatic disease and a diploid/near diploid DNA content had a significantly better survival rate than those with aneuploid primary tumors. Statistical analysis showed that grade and ploidy contributed significant but independent prognostic information. We concluded that DNA content is a useful prognostic factor in renal carcinoma.

Adult↗
PubMed1989

The relationship of deoxyribonucleic acid content to conventional prognostic factors in Wilms tumor.

Deoxyribonucleic acid ploidy as determined by flow cytometric analysis was compared to histological findings and tumor stage for accuracy of prediction of patient survival in a series of Wilms tumors. While anaplastic tumors were more likely aneuploid or tetraploid than diploid, no statistically significant relationship was found between deoxyribonucleic acid ploidy and patient survival in our series. Tumor histology and stage as defined by the National Wilms Tumor Study were more accurate predictors of patient survival than deoxyribonucleic acid ploidy.

Adolescent↗
PubMed1989

Early post-operative morbidity of total prostatectomy.

Complications were analysed in a contemporary series of 100 total prostatectomies performed, for carcinoma of the prostate, under the supervision of one surgeon. There were 7 major complications including 1 death. No patient had a rectal injury. Minor complications occurred in 33 patients. Severe stress incontinence persisted in only 2 patients and 12 had minor stress incontinence. Of 38 patients potent before surgery and in whom it was possible to preserve both "neurovascular bundles of Walsh", 45% retained post-operative potency. Preservation of potency was related to the pathological extent of the tumour. It was concluded that in selected patients, total retropubic prostatectomy can be performed safely with good quality of post-operative life.

Adenocarcinoma↗
PubMed1989

Extracorporeal piezoelectric lithotripsy for all renal stones: effectiveness and limitations.

An unselected group of patients with renal stones was treated with extracorporeal piezoelectric lithotripsy (EPL) monotherapy. The results showed that this minimally invasive treatment was very effective for patients with stones smaller than 20 mm. After a minimum follow-up of 1 month, 65% of these patients were stone-free and 22% of the remainder had only small fragments. Patients with larger stones (20 mm or larger) required multiple treatment sessions (mean 5.8) and had less favourable results. One month or more after treatment, only 46% of these patients were free of stone and 21% required secondary operative procedures for obstructing ureteric fragments. Most of these patients are better treated initially by percutaneous nephrolithotomy.

Adolescent↗
PubMed1989

Carcinoma of the prostate.

In Scotland, carcinoma of the prostate is now the third most common malignancy in males. The disease is only curable if removed or irradiated when confined to the prostate but has usually spread beyond the prostate when the diagnosis is made. This article reviews the clinical presentation, diagnostic and staging methods and current treatment available for this common clinical problem.

Aftercare↗
PubMed1988

Spontaneous regression of liver metastasis from renal carcinoma.

Idiopathic regression of metastases from renal carcinoma is rare and usually involves lung metastases in men with a good performance status following removal of the primary tumor. We report a case of spontaneous regression of a biopsy proved liver metastasis that had appeared several months after removal of primary renal carcinoma.

Carcinoma, Renal Cell↗
PubMed1988

The significance of atypia in fine needle aspiration cytology of the prostate.

Of 411 fine needle aspirates of the prostate 208 could be matched with conventional pathological material. Cytological diagnosis had a complete sensitivity of 94 per cent, specificity 99 per cent and efficiency 74 per cent. Corresponding figures for 36 patients who underwent total prostatectomy were complete sensitivity 100 per cent, specificity 100 per cent and efficiency 78 per cent. Atypical cytology results not amounting to frank malignancy were the main reasons for reduced efficiency and, therefore, analysis of the significance of atypia was performed. In 50 aspirates from 43 patients atypia of varying degree was noted but the degree of atypia did not allow for a diagnosis of malignancy. Subsequent diagnosis of carcinoma was made by cutting needle biopsy or transurethral resection in 7 of 14 specimens (50 per cent) of severe, 3 of 9 (33 per cent) moderate, 3 of 7 (43 per cent) mild and 3 of 16 (19 per cent) reactive atypia. Thus, specific cytological diagnoses have a high degree of accuracy but atypia and attempts to categorize it did not predict accurately the final diagnosis. Pathological conditions that may account for atypia in fine needle aspiration cytology are reviewed.

Adenocarcinoma↗
PubMed1988

Relationship of DNA content to conventional prognostic factors in clinically localised carcinoma of the prostate.

One hundred and nine patients treated by total prostatectomy for apparently localised carcinoma were analysed to investigate the prognostic significance of capsular invasion and penetration, seminal vesicle invasion, lymph node metastases, grade as assessed by the Gleason and MD Anderson Hospital (MDAH) systems and DNA content measured by flow cytometry of nuclear material extracted from paraffin embedded tumour. Comparison of DNA content was made with 36 benign prostates. Mean follow-up/survival was 60.7 months, at which time 21 patients had evidence of recurrence or had died. Only 5 patients had local recurrence. Tumour grade, as assessed by both the Gleason Sum Score and the MDAH system, correlated with anatomical extent and was the most important determinant of time to recurrence. Fifty-nine tumours were diploid, 44 tetraploid and 6 aneuploid. One of 36 benign prostates showed aneuploidy. Ploidy did not correlate with the anatomical extent of the tumour or with grade. Tetraploid tumours recurred earlier than diploid tumours. None of 6 aneuploid tumours have recurred, although only 3 have been followed beyond 5 years. Multivariate analysis showed that after accounting for grade, none of the other variables, including ploidy, contributed any additional significant prognostic information. Although the results must be regarded as preliminary, in view of the small number of patients with recurrence, they suggest that DNA content offers limited prognostic information in clinically localised prostate cancer.

Aged↗
PubMed1988

Incidental renal neoplasms: incidence in Los Angeles County, treatment and prognosis.

The proportion of 3232 malignant renal parenchymal tumors diagnosed at an asymptomatic stage in Los Angeles County over a 13 year period was 15%. A comparison of the proportion of tumors that were asymptomatic at diagnosis over two four year periods, showed no significant change. Asymptomatic tumors were localized to the kidney in 77.5% of cases and had produced metastases in 9.4%. Conversely, symptomatic tumors were localized in only 43.9% and had metastases in 28%. These data are compared with recent literature concerning the incidence, diagnosis, pathology, prognosis and treatment of incidental renal neoplasms.

Adenoma↗
PubMed1987

Antibiotic prophylaxis for prostatic surgery. Single-dose cephradine compared with single-dose cefotaxime.

Several previous studies have attested to the value of antibiotic prophylaxis for prostatic surgery. We report a prospective randomised study which compared a single dose of cefotaxime with a single dose of cephradine given with the induction of anaesthesia. There was little difference between these regimens and it was concluded that either may be used, depending on availability and cost of the antibiotic. We have now completed a 5-year study of antibiotic prophylaxis for prostatic surgery and we also report the results of a long-term survey of the ward flora. There has been no significant change and there is no evidence for the emergence of resistant strains.

Aged↗
PubMed1987

Local immune responses after intravesical BCG treatment for carcinoma in situ.

The lymphoid cellular infiltrates in the bladder biopsies from patients with carcinoma in situ before and after BCG intravesical therapy have been determined and characterised. This has been achieved using a panel of monoclonal antibody probes in an indirect immunoperoxidase technique. These studies have revealed the predominance of T-cells of the helper/inducer phenotype (T4+), beta-lymphocytes (B1+) and macrophages (Leu M3+, 3.9+) in bladder biopsies after BCG therapy. HLA.DR antigens were also expressed on the lymphoid cells infiltrate as well as the urothelial cells. These results suggest that the components of an active immune response were present and enhanced in the bladder wall after BCG therapy.

Administration, Intravesical↗
PubMed1985

Prediction of response to radiotherapy for localised prostatic cancer.

Fifty-one patients with TO-4 NX MO carcinoma of the prostate were treated by external beam radiotherapy. Comparison with 40 patients with TO-3 NX MO disease, whose treatment was deferred initially, showed a higher incidence of local progression in the untreated patients. Age at presentation and initial T category did not have a significant influence upon the probability of disease progression after radiotherapy, whereas all but one of the irradiated patients with Gleason sum scores greater than or equal to 6 progressed. Treatment-related morbidity was appreciable and prolonged proctitis occurred in 31 patients. There was one treatment-related death. Biopsy 1 year after treatment did not yield information of prognostic significance. It is recommended that the selection of patients with localised carcinoma of the prostate for treatment by radiotherapy is based on histological grade. The Gleason score is a practical method for identifying those who would best be treated by other methods.

Aged↗
PubMed1985

Lymphocyte sub-populations in the male genital tract.

A series of monoclonal antibodies that react with human lymphocyte subsets was used in an indirect immunoperoxidase technique to study representative blocks from normal human testis, epididymis, vas deferens, prostate and seminal vesicles. Biopsies of testis, epididymis and vas obtained during surgical procedures directed at the investigation and treatment of infertile males were also studied. In all normal tissues, apart from the peripheral testis where no lymphocytes were identified, T lymphocytes were the predominant cell type (Leu 4+). These lymphocytes were largely of the suppressor/cytotoxic phenotype (Leu 2a+) and were more abundant in between the epithelial cells in the rete testis, epididymis, vas deferens, seminal vesicles and prostatic acini. Cells of the helper/inducer phenotype (Leu 3a+) were identified mainly within the interstitium of the epididymis and the prostate. B-lymphocytes (Leu 12+) were few in number and were mainly in the stroma of the prostate. In each organ the ratio of the T-cell subsets was determined and changes in this ratio were observed in epididymal and vasal biopsies from some infertile males. Finally, in testis biopsies from infertile men, suppressor/cytotoxic T-cells were demonstrated between the germinal epithelium and the fibrous tunica of the seminiferous tubules and as focal aggregates in the interstitium.

Antibodies, Monoclonal↗