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Biomedical subjects

F C Lowe

Publications and source records attributed to F C Lowe.

At least 55 records · Page 3Linked to original sources
PubMed1991

Identification of asymptomatic renal cell carcinomas utilizing modern radiographic techniques.

The more liberal use of ultrasonography and computed tomography has made more common the incidental discovery of renal masses. The charts of 105 patients surgically treated for renal cell carcinoma at a teaching hospital from 1983 to 1987 were reviewed. The incidence of incidentally found asymptomatic tumors was 47% (49/105 patients). Of the incidentally found tumors, 55% were stage I and only 14% were stage III; for symptomatic patients, 39% of tumors were stage I and 27% were stage III. This study also found that the classical triad of pain, hematuria, and flank mass was present in only 3.8% (4/105) of patients. Tumors found incidentally will usually be of lower pathologic stage and may carry a better prognosis.

Carcinoma, Renal Cell↗
PubMed1990

Indications for use of ketoconazole in management of metastatic prostate cancer.

Newer methods of androgen ablation for the treatment of metastatic prostatic carcinoma have been developed as alternatives to the standard forms of therapy, oral estrogens and surgical castration. The purpose of this review is to elucidate the indications and to determine the role of ketoconazole in the management of metastatic prostatic cancer. Eighteen patients have been treated with ketoconazole. The indications for usage have included: prompt therapeutic response, when orchiectomy is contraindicated, when estrogens are contraindicated, initial empirical therapy, and hormonally refractory disease. It can also be used in conjunction with luteinizing hormone-releasing hormone analogues. Ketoconazole is excellent for short-term usage prior to bilateral orchiectomy and when prompt therapeutic response is needed but orchiectomy cannot be performed. However, it is not particularly useful for long-term hormonal therapy.

Aged↗
PubMed1989

Computerized tomography in diagnosis of bladder rupture.

Patients with significant pelvic fractures and hematuria must be carefully evaluated for concomitant urinary tract injuries. Computerized tomography may be a useful adjunct to retrograde cystography for diagnosing bladder rupture in those patients with either equivocal or unexpectedly negative findings on cystograms.

Accidents, Traffic↗
PubMed1989

Computerized tomography in evaluation of transitional cell carcinoma in bladder diverticula.

Between 1981 and 1985, 6 patients with transitional cell carcinoma in bladder diverticula had preoperative computerized tomography (CT). CT suggested no invasion through the wall of the diverticulum in all 5 patients who had pathologic confirmation. CT is a useful staging procedure and is helpful in determining the management of patients with transitional cell carcinoma.

Aged↗
PubMed1989

Kaposi's sarcoma of the penis in patients with acquired immunodeficiency syndrome.

With the growing number of patients with the acquired immunodeficiency syndrome there has been a marked increase in the incidence of Kaposi's sarcoma. Kaposi's sarcoma of the penis was the initial presenting manifestation of acquired immunodeficiency syndrome in 4 patients. Overall, less than 3% of all acquired immunodeficiency syndrome patients with Kaposi's sarcoma have the initial lesion on the penis. However, eventually almost 20% of those with Kaposi's sarcoma will have lesions on the genitalia. Therefore, urologists must have an understanding of the entity and its management. A conservative approach to treatment of these lesions is recommended.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Ketoconazole in initial management and treatment of metastatic prostate cancer to spine.

Ketoconazole in high doses causes castrate levels of testosterone within twenty-four to forty-eight hours; therefore it is extremely useful in the initial medical treatment of patients with metastatic prostate cancer who need a prompt therapeutic response. Review of 17 patients who presented with severe radicular pain or acute paraparesis/paraplegia showed that there was frequent delay in urologic consultation, pathologic confirmation, and initiation of efficacious therapy. In fact, 5 of 12 patients (42%) who received radiation therapy prior to effective hormonal therapy suffered significant morbidity and mortality. The case is made for the use of ketoconazole for initial empirical therapy for these patients.

Humans↗
PubMed1988

Renal parenchymal neurilemoma: a rare and unusual kidney tumor.

We report a case of a neurilemoma arising from the renal parenchyma. Renal neurilemoma is an extremely rare tumor, with only 5 cases previously reported. Because so little is known of its natural history and potential for malignancy we recommend radical nephrectomy as the treatment of choice.

Female↗
PubMed1987

Barium granuloma: an unusual cause of unilateral ureteral obstruction.

A small amount of barium extravasated at the time of colonic surgery led to the development of a barium granuloma that caused unilateral ureteral obstruction. Although the barium was not detected on radiography or urography preoperatively, it was clearly visible at the time of ureteral exploration and ureterolysis.

Barium Sulfate↗
PubMed1987

Potency following radical prostatectomy with wide unilateral excision of the neurovascular bundle.

Delineation of the neurovascular bundles has made it possible to identify the branches of the pelvic plexus to the corpora cavernosa intraoperatively and to decide whether the bundles can be preserved or resected widely with the specimen. In the course of performing 312 radical retropubic prostatectomies the neurovascular bundle was widely excised unilaterally in 49 men with advanced clinical disease in whom, based on preoperative or intraoperative assessment, the bundle appeared to be involved by tumor. Because of this selection criterion these patients had higher clinical stage (52 per cent had clinical stage B2) and pathological stage (35 per cent had microscopic involvement of pelvic lymph nodes) disease than our previously reported series. In 38 patients the margins of resection were negative for tumor. In 11 patients despite attempts at wide excision of the lesion the surgical margins of resection were positive. In all 11 men with positive surgical margins there was extensive periprostatic extension of tumor and 8 had involvement of the pelvic lymph nodes. However, in none of the 11 patients with positive surgical margins were the margins positive only at the site where the bundle was spared, which shows that unilateral sparing of the neurovascular bundle did not compromise removal of tumor. Of the 29 men who were potent preoperatively and who have been followed for 1 year or longer postoperatively 20 (69 per cent) are potent. The return of sexual function correlated with age: 5 of 5 men (100 per cent) 40 to 49 years old were potent postoperatively compared to 8 of 10 (80 per cent) 50 to 59 years old and 7 of 14 (50 per cent) 60 to 69 years old. Histological evaluation of the resected specimens revealed that some of the men who were potent postoperatively had soft tissue and nerves resected in the region of the contralateral spared neurovascular bundle. By measuring nerves in the spared region of the neurovascular bundle we found that the role of the neurovascular bundles in potency is not owing to large nerves but to many nerves of varying size. In conclusion, potency can be maintained after radical prostatectomy in most patients in whom it is necessary to excise 1 neurovascular bundle widely without compromising the removal of tumor.

Adult↗
PubMed1987

Intravesical herniation of small bowel after bladder perforation.

Intravesical small bowel herniation is a rare complication of bladder perforation, with only 1 case reported previously. We describe 2 additional patients in whom the diagnosis of bladder perforation was delayed or made difficult because the herniated small bowel presented as a filling defect without significant extravasation of contrast medium on cystography. In both patients additional investigative procedures were necessary to establish the diagnosis preoperatively.

Accidental Falls↗
PubMed1987

The use of ketoconazole in the emergency management of disseminated intravascular coagulation due to metastatic prostatic cancer.

The disseminated intravascular coagulation syndrome is an untoward side effect of metastatic adenocarcinoma of the prostate. In addition to appropriate replacement of blood, platelets and clotting factors, prompt treatment of the prostatic carcinoma is required to correct the underlying pathophysiological defect. Ketoconazole is the ideal method for hormonal manipulation for patients with life-threatening complications of prostatic carcinoma (disseminated intravascular coagulation and acute paraparesis/paraplegia) because of its prompt onset of action in decreasing circulating concentrations of androgens to castrate levels. Serum testosterone levels are castrate within 48 hours of the initiation of therapy with ketoconazole as opposed to a minimum of 10 to 14 days with estrogens. A patient with spontaneous bleeding from disseminated intravascular coagulation was treated with 400 mg. ketoconazole every 8 hours and bleeding stopped within 48 hours. Ketoconazole is particularly valuable when a prompt therapeutic response is needed and orchiectomy is contraindicated because of bleeding diathesis (as in disseminated intravascular coagulation), delay in histological confirmation (as in acute paraparesis/paraplegia) or patient reluctance to undergo castration.

Adenocarcinoma↗
PubMed1986

Monitoring radiation exposure to medical personnel during percutaneous nephrolithotomy.

To ascertain radiation exposure to medical personnel during percutaneous nephrolithotomy, lithium fluoride thermoluminescent dosimeters (TLDs) were utilized for the radiographic monitoring of 7 consecutive patients. Average fluoroscopy time per procedure was 27.8 minutes of which 15.1 minutes were for nephrostomy tube insertion and 12.7 minutes were for calculi extraction. The 2 radiologists received 4.5 and 5.1 mrad per procedure, while the 2 urologists received 2.5 and 3.7 mrad. All other ancillary personnel received less than 2.1 mrad per procedure except the anesthesiologists whose mean exposure was 4.7 mrad. By taking appropriate precautions and using the proper equipment, percutaneous nephrolithotomy can be performed with a low level of radiation exposure for all involved physicians and personnel.

Adult↗
PubMed1986

Localized gangrene of the scrotum and penis: a complication of heroin injection into the femoral vessels.

Long-term intravenous heroin abusers have problems of vascular access. After the accessible sites are sclerosed, the neck, axillae and groins are then used frequently. We report on 3 heroin abusers who presented with localized gangrene of the genitalia after injection into the femoral vessels. We postulate that the pathophysiology of this entity is related to arterial embolization of particulate matter into the microcirculation of the genitalia, which causes arterial thrombosis leading to localized gangrene. Of the 3 patients 2 were treated with local excision, débridement and primary closure. A fourth addict who injected heroin directly into the scrotum and perineum, presented with Fournier's gangrene, a completely different, more lethal entity.

Adult↗
PubMed1986

Urethral prolapse in children: insights into etiology and management.

The pathophysiology of urethral prolapse has never been clearly elucidated. Following en bloc removal of the urethra, bladder, vagina, uterus and pelvic floor tissues from a 4-year-old burn victim with urethral prolapse at the time of death and from a female newborn cadaver, careful step-sectioning of the specimens at 5 mm. intervals for histological examination was performed. The anatomical defects of urethral prolapse noted were marked eversion of the urethral mucosa, vascular congestion of the "corpus spongiosum urethrae muliebris", and a cleavage plane between the inner longitudinal and outer circular-oblique smooth muscle layers of the urethra. We propose that urethral prolapse results from poor attachments between the smooth muscle layers of the urethra in association with episodic increases in intra-abdominal pressure. A clinical review of 12 cases revealed that at least 8 (67 per cent) had antecedent episodes of marked increases in intra-abdominal pressure. Obliteration of the cleavage plane between the smooth muscle layers is important for successful treatment of this lesion.

Abdomen↗
PubMed1985

Squamous cell carcinoma of scrotum.

Squamous cell carcinoma of the scrotum is a rare malignancy in the United States. This series includes the eighth reported case of this lesion in a black American. Surgery still remains the only effective therapeutic modality. The use of sentinel and superficial inguinal node biopsies was important in determining whether or not radical ilioinguinal lymphadenectomy was needed in 2 patients.

Aged↗
PubMed1985

Cutaneous horns of the penis: an approach to management. Case report and review of the literature.

Cutaneous horns of the penis are rare lesions, only seventeen previous cases having been reported in the English literature. The lesions usually appear following adult circumcision for long-standing phimosis. Frequently they are unusual presentations for squamous cell carcinoma of the penis. One third of the cases of penile horns were associated with underlying malignancies; therefore prompt surgical intervention is warranted.

Aged↗