Biomedical subjects
Publications and source records attributed to D F Lynch.
Regulations currently in force governing the flight status of military aviators with urinary calculus disease are more restrictive than necessary and result in a substantial loss of aviation manpower. Those regulations and policies currently in force are reviewed, and more liberal guidelines, designed to provide for the safe return to useful flight status of aviation personnel with renal stone episodes, are proposed.
Supraclavicular node biopsy has been advocated previously as a routine staging procedure for patients with testicular tumors. Of 73 patients with testis tumors the scalene node biopsy revealed metastasis in only 3 of 61 patients with non-seminomatous tumors and in 1 of 12 patients with seminoma. Furthermore, all 4 patients were known to have other metastases; in 3 of the 4 patients a palpable supraclavicular mass was noted as well. The low yield of this procedure, in conjunction with a complication rate of 8%, mitigates against the routine use of supraclavicular node biopsy in patients without a palpable supraclavicular mass.
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Sandwich therapy, a regimen of lymphadenectomy combined with preoperative and postoperative cobalt teletherapy, yielded a survival rate of 84% in 13 patients with stages A and B non-seminomatous testis tumor. This statistic is consistent with the previously reported survival rate of 83% achieved among 35 patients treated with this regimen from 1958 to 1970 at our institution. Bone marrow depression, retroperitoneal fibrosis and possible induction of a second malignancy were important side effects of radiation therapy. The superior survival rates with fewer severe side effects of treatment obtained by other investigators using either lymphadenectomy alone or lymphadenectomy combined with chemotherapy have prompted us to discontinue sandwich therapy as standard treatment for non-seminomatous testis tumors at our institution.
During the past seven years, 14 pregnant patients were admitted to our hospital for treatment of ureteral calculus. During this same period, 22,495 deliveries were performed, for an incidence of one calculus per 1,600 pregnancies. Eleven patients spontaneously passed the calculus, ten prior to delivery and one patient postpartum. Three patients required an operation, two antepartum and one patient postpartum. No maternal or fetal complications occurred. Management of urinary calculi during pregnancy must be individualized and should be based upon location of the stone, degree of obstruction, presence or absence of infection, general condition of the patient and stage of pregnancy. Surgical intervention to remove obstructing calculi is not contraindicated during pregnancy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.