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Biomedical subjects

E A Klein

Publications and source records attributed to E A Klein.

At least 109 records · Page 6Linked to original sources
PubMed1992

Early continence after radical prostatectomy.

A prospective evaluation of urinary continence in 60 consecutive patients undergoing radical prostatectomy with incorporation of the fascia posterior to the urethra into the vesicourethral anastomosis is described. With this technique complete continence without the need for pads has been achieved in 88% of the patients, with stress incontinence in 10% and total incontinence in 2%. Continence was achieved within 1 to 16 weeks, with 13% of the patients dry during week 1, 55% dry at 6 weeks and 83% dry at 3 months. The median interval to achieve continence was 5 weeks. Median age of the continent patients was significantly lower than that of incontinent patients (65 versus 69 years). Neither the number of neurovascular bundles resected nor the need to reconstruct the vesical neck affected the rate of continence. While the exact mechanism of continence after radical prostatectomy remains unknown, incorporation of the fascia posterior to the urethra into the vesicourethral anastomosis results in earlier continence and thereby lessens the morbidity of this procedure.

Anastomosis, Surgical↗
PubMed1992

Functional equivalence of end and loop ileal conduit stomas.

A total of 458 patients underwent ileal conduit urinary diversion between 1970 and 1984. An end stoma was constructed in 44% of the patients and a Turnbull loop stoma in 56%. The median interval between appliance changes for all patients was 5 days. Patients with an end stoma had a longer median interval between appliance changes than those with a loop stoma. A total of 51 patients had 66 complications. Operations for stomal revisions were required in 5.5% of the patients. There was no difference in interval until initial complication between the end and loop stoma groups, although the end stoma was more prone to ischemic complications than the loop stoma. We conclude that the ileal conduit stoma constructed in an end or loop fashion yielded clinically equivalent long-term function.

Adolescent↗
PubMed1992

Management of local bacillus Calmette-Guerin failures in superficial bladder cancer.

We attempt to define the treated natural history of patients with superficial bladder tumors (stages Ta, TIS and T1) managed with intravesical bacillus Calmette-Guerin (BCG) to determine the best form of treatment for locally recurrent tumors. The management and survival of 41 patients who failed BCG within the bladder or prostatic urethra and who subsequently were treated with a variety of secondary therapies are reviewed. Our aim was to assess the role of several independent clinical variables on the rate of death from bladder cancer. Of the 41 patients 6 (15%) died. Univariate statistical analysis identified early involvement of the prostatic urethra and the presence of superficially invasive (stage T1) tumor at initial treatment with BCG as factors having an adverse effect on survival. A multivariate statistical model revealed that patients with early prostatic urethral involvement and the presence of superficially invasive (stage T1) tumor at diagnosis had the highest risk of death from bladder cancer. The reason for change in therapy at failure of BCG, stage of the tumor at BCG failure, occurrence of upper tract tumors and early versus delayed radical cystectomy had no impact on survival. The results suggest that not all tumors that recur after BCG are destined to proceed to muscle invasion or metastases, and that some patients may be managed safely by repeated endoscopic resection and intravesical therapy with cystectomy delayed until objective progression is evident. Such an approach can yield survival equal to that in patients treated with early cystectomy and may result in longer intervals of bladder preservation in a select subset of patients who fail BCG locally.

BCG Vaccine↗
PubMed1992

Increased prostaglandin E2 and cAMP phosphodiesterase levels in Kaposi's sarcoma--a virus against host defense mechanism.

In Kaposi's sarcoma tissue, prostaglandin E2 (PgE2) levels and cAMP phosphodiesterase levels were found to be higher than in surrounding normal tissue. We have shown earlier that PgE2 suppresses interferon (IFN) alpha production. High levels of cAMP phosphodiesterases result in low cAMP levels. Thus, this phenomenon may be involved in altered immunologic resistance, growth and differentiation.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1991

Local BCG failures in superficial bladder cancer. A multivariate analysis of risk factors influencing survival.

Of 221 patients with superficial bladder cancers treated with intravesical BCG, BCG therapy failed locally within the bladder or prostate in 41 patients. A multivariate analysis was done using data on these local failures to identify clinical variables influencing survival. Patients presenting with T1 tumors which relapsed initially in the prostate were at highest risk of dying of bladder cancer. Cystectomy is justified in such patients. Others with noninvasive local refractory disease can be managed by continued conservative therapy.

Analysis of Variance↗
PubMed1991

Management of renal cell carcinoma with vena caval thrombi via cardiopulmonary bypass and deep hypothermic circulatory arrest.

Cardiopulmonary bypass with deep hypothermic circulatory arrest allows safe and effective removal of renal tumors with extensive thrombi involving the vena cava under controlled circumstances without permanent side effects. The technique averts extensive dissection of the inferior vena cava and occlusion of major vessels while providing up to 60 minutes of safe operating time in a bloodless field and complete visibility of the interior of the vena cava. Adjunctive procedures for tumor excision or cardiac revascularization can be performed at the same time without increased operative risk.

Carcinoma, Renal Cell↗
PubMed1991

Partial and total penectomy for cancer.

Squamous carcinoma of the penis remains an uncommon tumor in the United States. In the properly selected patient, partial or total penectomy performed with an understanding of the salient surgical anatomy results in adequate local control of these cancers with excellent functional and cosmetic results.

Biopsy↗
PubMed1990

Absence of structural alterations of the multidrug resistance genes in transitional cell carcinoma.

Tumor DNA from 27 patients with treated or untreated transitional cell carcinomas of the urinary tract was screened for genomic alterations of the multidrug resistance genes in order to determine whether structural changes of these genes are important in primary urothelial tumors. None of the tumors showed evidence of amplification or rearrangements of either mdr1 or mdr2. The lack of amplification or rearrangements observed in these tumors suggests that structural alterations of the mdr1 and mdr2 genes are not important mediators of drug resistance in TCC.

Blotting, Southern↗
PubMed1990

The immunotherapy and cellular biology of renal cell carcinoma.

It is clear from the work presented at this symposium that immunotherapy has joined surgery, chemotherapy, and radiation as the next generation of treatment for at least some human malignancies. Several problems remain to be addressed before the use of immunotherapy is optimized, including: (1) understanding the genetic and cellular growth control mechanisms gone awry in the development and progression of RCC; (2) defining the mechanisms by which antitumor lymphocytes are cytotoxic; (3) establishing an inexpensive and less labor-intensive way of identifying and isolating the most active antitumor lymphocytes from LAK cells and TILs; (4) designing methods to optimize delivery of effector cells to tumor beds; and (5) exploiting combinations of immune effectors and other therapies for improved killing of cells and lower toxicity. Answers to these problems will no doubt form the basis for future symposia.

Carcinoma, Renal Cell↗
PubMed1989

Detection of posttransplant minimal disease chronic myelogenous leukemia by bcr rearrangement analysis.

Until recently, cytogenetic detection of the Philadelphia chromosome (Ph) was the only reliable test to diagnose chronic myelogenous leukemia (CML) and detect minimal disease or early relapse following treatment. However, the recently developed ability to detect the Ph chromosome as a rearrangement in the bcr gene of chromosome 22 permits identification of the leukemic clone comprising as little as 5% of the cell population. We present results of simultaneous cytogenetic and DNA rearrangement studies in 28 CML patients considered for or treated with bone marrow transplantation. Our results show that the molecular method is significantly more sensitive than the cytogenetic method in the detection of minimal disease Ph-positive clones.

Bone Marrow Transplantation↗
PubMed1986

Noninvasive testicular screening in childhood leukemia.

To evaluate the potential of transscrotal ultrasound and magnetic resonance imaging as noninvasive screening methods we studied 8 boys with acute lymphocytic leukemia before testicular biopsy. Ultrasonic images of the testes were performed in 4 patients, including 2 with negative and 2 with positive biopsies, and all images were interpreted as normal. Magnetic resonance images of the testes also were interpreted as normal in 4 patients, including 2 with negative and 2 with positive biopsies, and they were technically inadequate in the remaining 4. The results suggest that neither transscrotal ultrasonography nor magnetic resonance imaging as currently applied may substitute reliably for testicular biopsy as a screen for occult testicular leukemia.

Adolescent↗
PubMed1986

Jejunal conduit urinary diversion.

The clinical course of 14 patients undergoing jejunal conduit urinary diversion between 1971 and 1985 is reviewed. Indications for use of jejunum rather than ileum or colon for diversion included radiation changes of the ileum, concurrent colonic neoplasms or injury, concerns about collateral blood supply of the colon and multiple adhesions. There were 2 operative deaths. Followup in the remaining 12 patients was 1 to 116 months (mean 34 months). All of the patients had satisfactory postoperative renal function. Eight patients (67 per cent) experienced a total of 13 complications. Only 3 patients (25 per cent) suffered the electrolyte imbalance characteristic of jejunal conduit syndrome, representing the only complication directly attributable to the use of jejunum. The jejunal conduit is a viable alternative form of urinary diversion in patients in whom the use of other intestinal segments is undesirable because of previous irradiation, surgery or concurrent disease processes. Although jejunal conduits carry an increased risk of electrolyte imbalance, the use of short jejunal loops and prophylactic oral electrolyte replacement therapy can minimize the occurrence of this complication.

Adult↗
PubMed1986

Retained straight catheter: complication of clean intermittent catheterization.

Clean intermittent catheterization is a simple and widely used technique with relatively few complications. A child on intermittent catheterization recently was treated for a retained straight catheter. Removal of the catheter was accomplished by urethral dilation. Proper technique of catheter insertion can prevent this complication.

Child, Preschool↗
PubMed1985

Priapism associated with the use of intravenous fat emulsion: case reports and postulated pathogenesis.

During the 8 years since inception of a home total parenteral nutrition program in 35 male patients 2 suffered priapism related temporally to the weekly intravenous infusion of 20 per cent fat emulsion. Fat emulsions have been shown to cause hypercoagulability, capillary thrombosis and fat embolus in in vivo and in vitro experiments. Autopsies of patients treated with intravenous fat emulsion have revealed capillary engorgement and fat embolus with associated organ infarction. We postulate that fat emulsions may cause priapism in these patients. Because of the more frequent occurrence of priapism in this small subset of patients we now recommend that 1) patients be informed of this potential complication before hyperalimentation is begun, 2) the less concentrated 10 per cent emulsion should be used twice weekly, rather than the 20 per cent emulsion weekly, and should be infused during at least 4 hours, and 3) the fat emulsion should be added to other components of the intravenous regimen, when possible, to dilute the fat and prolong its administration time.

Adult↗
PubMed1985

Intraoperative consultation for the retroperitoneum and adrenal glands.

An incidentally discovered mass lesion is the most frequent indication for intraoperative consultation involving the retroperitoneum or adrenal gland. The goal of the surgeon is to determine the nature and extent of the lesion and, for solid lesions, to obtain a biopsy adequate for histopathologic diagnosis. Benign lesions may be excised locally, whereas therapy for malignancies depends upon the individual circumstances of the patient, the histology of the lesion, and involvement of adjacent organs. Treatment of hematomas requires early vascular control. Adrenal tissue should be preserved whenever possible.

Abscess↗