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Biomedical subjects

J E Fowler

Publications and source records attributed to J E Fowler.

At least 91 records · Page 5Linked to original sources
PubMed1987

Early experience with Walsh technique of radical retropubic prostatectomy.

We analyzed the operative experience and postoperative and late complications of pelvic lymphadenectomy and radical retropubic prostatectomy in 27 consecutive cases in which the modifications of prostatectomy described by Walsh were employed, and compared the results with those of 29 cases performed in the preceding three years when the Campbell technique of prostatectomy was employed. The mean operative time, mean blood loss, and incidences of early postoperative complications and incontinence were less for patients treated with the Walsh technique than with the Campbell technique. After surgery 85 per cent of evaluable patients remained potent with the Walsh technique compared with 16 per cent of patients treated with the Campbell technique. Although other factors besides operative approach may have biased our results, we are persuaded that the innovations of radical retropubic prostatectomy detailed by Walsh constitute important advances in surgical technique, and we now use this procedure in all suitable patients electing treatment by radical prostatectomy for localized prostatic cancer.

Erectile Dysfunction↗
PubMed1987

Interaction of urinary Tamm-Horsfall protein with transitional cells and transitional epithelium.

Uropathogenic E. coli that express mannose sensitive adhesins adhere to agglutinated urinary Tamm-Horsfall protein (THP) and to exfoliated transitional epithelial cells coated with THP. Whether THP interacts with the transitional epithelium in vivo and facilitates adhesin mediated attachment of E. coli is not known. Using immunohistochemical techniques we could not identify THP associated with formalin-fixed, paraffin-embedded transitional epithelium from a variety of sites within the urinary tract. However, varying levels of THP associated with the washed exfoliated transitional cells from 10 different subjects were detected by indirect radioimmunoassay methodologies. After in vitro incubation in human urine the mean interaction of THP with the exfoliated transitional cells increased significantly but closely paralleled the mean interaction of THP with exfoliated vaginal and buccal epithelial cells after identical incubation. We conclude that the interaction of THP with transitional cells in vivo is nonspecific and occurs after detachment from the mucosa. THP may act as a natural host defense against E. coli bacteriuria by inhibition of adhesion mediated bacterial adherence to the urothelium.

Adhesins, Escherichia coli↗
PubMed1987

Effect of liquid diphenoxylate hydrochloride and atropine sulfate (Lomotil) instillations on dynamics and function of continent cecal urinary reservoirs.

We assessed the impact of twice daily instillations of 10 ml. liquid diphenoxylate hydrochloride and atropine sulfate (Lomotil) on the dynamics and function of continent urinary reservoirs constructed from intact cecum and ascending colon. Six patients were treated for 1 to 3 weeks at 3 to 8 months postoperatively. The treatments reduced the frequency of spontaneous reservoir contractions, as well as the basal and contraction pressures of the reservoirs. The reservoir capacities were increased modestly. These alterations in reservoir dynamics were accompanied by a decrease in the cramping characteristically associated with reservoir distension and increased intervals between reservoir catheterization. Two patients who had incontinence after initially successful operations regained continence during treatment. No systemic side effects were observed, although dilution of the drug may be required to prevent reservoir irritability. Diphenoxylate hydrochloride and atropine sulfate instillations may prevent acute and possibly long-term pressure-related complications of continent urinary reservoirs constructed from intact cecum and ascending colon.

Atropine↗
PubMed1987

Small cell undifferentiated carcinoma of the urinary bladder. A light-microscopic, immunocytochemical, and ultrastructural study of 12 cases.

The clinicopathologic, immunocytochemical, and ultrastructural features of 12 small cell undifferentiated carcinomas (SCUCs) of the urinary bladder are herein reported. The patients ranged in age from 50 to 82 years (median, 76 years). Ten patients were male and two were female. Gross hematuria was the most frequent complaint (67%). Five patients died of disease (median survival, 4 months), three patients are still living with unresectable disease after 6, 10, and 12 months, and four patients were only recently diagnosed. Grossly, most of the tumors were large polypoid masses. On light-microscopic examination, they resembled the intermediate and oat cell variants of pulmonary SCUC. Eight SCUC were associated with other forms of in situ or invasive carcinoma, including transitional cell carcinoma (seven cases), adenocarcinoma (three cases), squamous cell carcinoma (three cases), spindle cell carcinoma (one case), and atypical carcinoid tumor (one case). Immunocytochemically, 11 of the 12 tumors expressed one or more epithelial cell markers (epithelial membrane antigen, human milk fat globule protein-2, cytokeratin). Eleven of the 12 SCUCs were also positive for one or more neuroendocrine markers (neuron specific enolase, chromogranin, Leu-7, vasoactive intestinal polypeptide, serotonin). Electron microscopy performed on seven tumors demonstrated dense-core granules (150-250 nm) in all cases, with tonofilaments in four cases, dendrite-like processes in two cases, and intercellular lumina in one case. The clinicopathologic features of 18 previously reported SCUC of the urinary bladder are also reviewed. SCUC arising in this location is an aggressive neoplasm that often demonstrates multidirectional differentiation, including the frequent but not invariable expression of neuroendocrine features.

Aged↗
PubMed1987

Renal trauma in rural Virginia.

We analyzed the cause and nature of renal injuries in a rural environment, and the results of a conservative management program. Over a 10-year period there were 148 patients with nonpenetrating renal injuries and seven with penetrating renal injuries. Nine of the patients with nonpenetrating injuries (6%) had major renal parenchymal injuries and were observed. None required operation and followup in eight of nine suggested no renal functional impairment. Six patients with penetrating injuries underwent exploration and four required nephrectomy for major renal parenchymal or renal pedicle injuries. We conclude that a conservative approach to nonpenetrating minor and major renal parenchymal injuries may be successful.

Humans↗
PubMed1987

Nephrectomy in metastatic renal cell carcinoma.

Progress in the treatment of metastatic renal cell carcinoma in recent decades might be characterized as promising by the optimist, nonexistent by the pessimist, and somewhere between by the realist. Regardless of one's point of view, the dilemma of what to do with the primary tumor persists. With notable exceptions, the duration and quality of survival are not influenced favorably by nephrectomy.

Carcinoma, Renal Cell↗
PubMed1986

Gleason histologic grading of prostatic carcinoma. Correlations between biopsy and prostatectomy specimens.

The Gleason histologic score of prostatic adenocarcinoma in biopsy specimens (needle cores or transurethral chips) was compared with the Gleason score of corresponding radical prostatectomy specimens from 53 patients with localized prostatic carcinoma. The Gleason score assigned to the biopsy specimen was identical to that of the prostatectomy specimen in 51% of cases, was greater than that of the prostatectomy specimen in 4%, and was less than that of the prostatectomy specimen in 45%. The magnitude of discrepancy between the scores of the biopsy specimen and the prostatectomy specimen was directly related to the quantity of neoplastic tissue in the biopsy specimen. Discrepancies between the Gleason score of biopsy material and prostatectomy specimens were greater among biopsy specimens with low Gleason scores as compared with biopsy specimens with high Gleason scores. Given the small number of cases, these differences were not statistically significant. Clinical understaging of the primary tumor did not correlate with histologic undergrading of the prostatectomy specimen. It was concluded that prostatic biopsy should be repeated when the initial diagnosis of adenocarcinoma is based on only limited quantities of neoplastic tissue with a low Gleason score and management decisions may be influenced by the true Gleason score of the tumor.

Adenocarcinoma↗
PubMed1986

Polyglycolic acid mesh in experimental renal trauma.

We investigated the efficacy of kidney wrapping with polyglycolic acid (PGA) mesh for control of hemorrhage and preservation of renal function following extensive potentially lethal kidney lacerations in the dog. Wrapping of lacerated kidneys resulted in reapposition of the renal parenchyma and prompt, sustained hemostasis. At 21 days following injury the renal lacerations were well healed. Among five dogs with lacerations involving the entire surface of one kidney, the mean of the ratios of the creatinine clearance of the affected kidney divided by the creatinine clearance of the uninjured contralateral kidney was 0.83 +/- 0.14. Among ten dogs with lacerations confined to the lower pole of one kidney, five were treated by mesh wrapping and five by partial nephrectomy. The mean of the ratios of the creatinine clearance of the affected kidney divided by the creatinine clearance of the uninjured contralateral kidney was 0.93 +/- 0.17 for the former group and 0.58 +/- 0.06 for the latter group. Perirenal infection following kidney wrapping developed in only one dog who had an E. coli bacteriuria at the time of injury. Blood pressure was monitored in eight dogs treated with mesh wrapping. None became hypertensive. These data suggest that PGA mesh may have clinical utility in the management of selected renal injuries in humans.

Animals↗
PubMed1986

Failure of immunotherapy for metastatic renal cell carcinoma.

Prompted by reports of tumor regression among patients with metastatic renal cell carcinoma treated by injection of an aggregated autologous or allogeneic tumor antigen with a nonspecific adjuvant, we studied the efficacy of this therapy in 23 patients. Following nephrectomy or excision of a metastatic lesion 16 patients were treated with an aggregated autologous tumor antigen combined with Candida albicans antigen. There were only 2 minimal responses. Seven patients judged unsuitable for an operation were treated with an aggregated allogeneic antigen. There were no objective responses. We conclude that these treatment regimens have minimal activity against metastatic renal cell carcinoma.

Adult↗
PubMed1986

Urinary tract infections in women.

Bacteriuria in the adult female is properly classified according to the pathogenesis and frequency of the infectious process. The vast majority of infections are reinfections that are characterized by sequential infections caused by different organisms. Reinfections result from inoculation of bladder urine in the sterile urinary system by enterobacteria from the vaginal flora and may be occasional or frequent. Susceptibility to frequent reinfections is due to enhanced colonization of the vaginal mucosa by enterobacteria. Persistent infections are characterized by sequential infections caused by the same organism. These infections, which are always frequent, usually result from the continued inoculation of urine by an infected focus within the urinary system. Because of the expense of health care, the efficacy of antimicrobial therapy for reinfections, and the infrequency of serious morbidity associated with reinfections, the rationale for traditional components of patient management has been questioned. An analysis of diagnostic and treatment options and recommendations for the management of bacteriuric women seen by the urologist has been presented.

Anti-Bacterial Agents↗
PubMed1986

Experience with suprapubic vesicourethral suspension and endoscopic suspension of the vesical neck for stress urinary incontinence in females.

The morbidity and efficacy of suprapubic vesicourethral suspension and endoscopic suspension of the vesical neck for correction of stress urinary incontinence in females were analyzed. Between 1974 and 1981, 41 women were treated with the former procedure and between 1981 and 1984, 50 were treated with the latter. The two treatment groups were well matched with respect to age, duration of incontinence, grade of incontinence, previous unsuccessful anti-incontinence surgical procedures and experience of the operating surgeon. The incidences of excessive intraoperative blood loss, postoperative abdominal complications and late complications in the suprapubic suspension group were 7, 14 and 2 per cent, respectively, and in the endoscopic suspension group, zero, zero and 2 per cent, respectively. The mean duration of postoperative hospitalization in the suprapubic suspension and the endosocpic suspension groups were 9.4 and 6.9 days, respectively. Seventy-three per cent of the patients treated by suprapubic suspension (mean duration of follow-up 71 months) and 86 per cent of the patients treated by endoscopic suspension (mean duration of follow-up 19 months) were cured. We conclude that the morbidity of endoscopic suspension is less than that of suprapubic suspension and that the early results of endoscopic suspension are equivalent.

Adult↗
PubMed1985

Radical prostatectomy for stage A2 and B prostatic carcinoma. Operative experience.

We compared the operative experiences and the postoperative and late complications of radical prostatectomy in 17 patients with Stage A2 and 64 patients with Stage B prostatic cancer. The operative time, estimated blood loss, incidence of intraoperative complications, frequency of surgical specimen fragmentation, and duration of hospitalization were similar for the two groups when stratified by surgical approach. Postoperative complications were more frequent in the Stage B group. Six per cent of the patients in each group were severely incontinent after surgery. In this experience recent partial prostatectomy did not appear to increase the risks of radical prostatectomy or decrease the likelihood of complete excision of the prostate.

Adenocarcinoma↗