Biomedical subjects
J K Lattimer
Publications and source records attributed to J K Lattimer.
Pregnancy in women with bladder exstrophy.
Little is known about pregnancies in women with bladder exstrophy. Of 28 women with bladder exstrophy who were evaluated 7 became pregnant and 5 delivered successfully. Problems seen during pregnancy, the long-term effects and the need for early, informed counseling by the urologist are discussed.
Long-term followup after exstrophy closure: late improvement and good quality of life.
Now that we have observed the growth and development of 17 of our anatomically reconstructed exstrophy patients through 20 or more years of followup, we are convinced that reconstruction should be the preferred primary treatment. Most of these patients are healthy, attractive, well educated adults and have achieved emotional maturity and stability, despite their many problems. Anatomical reconstruction also has considerable advantages over other current treatments for exstrophy that were not apparent initially.
Urinary tract reconstruction following loop cutaneous ureterostomy.
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Government pressures on urological education.
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George Winthrop Fish. 1896-1977.
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Male exstrophy patients: a preliminary report on the reproductive capability.
Semen analyses from 9 male patients with bladder exstrophy revealed a high incidence of infertility (7 cases). Possible causes and measures that might help to preserve the fertility potential are suggested.
Bone marrow acid phosphatase: prognostic value in patients undergoing radical prostatectomy.
Preoperative bone marrow acid phosphatase determinations were elevated in 18 of 31 patients who underwent radical prostatectomies. A review of the surgical pathology and clinical followup demonstrated a higher incidence of metastasis in these patients.
Radical retropubic prostatectomy for cancer: a 20-year experience.
A review of 159 patients treated by radical retropubic prostatovesiculectomy from 1951 through 1970 has reinforced our belief that this is a satisfactory method of treatment for prostatic cancer confined to the prostate. A 10-year survival of 55 per cent and a 15-year survival of 45 per cent compare well to the results reported for perineal prostatectomy. The postoperative mortality rate was 2.5 per cent and total incontinence was 12.5 per cent after radical retropubic prostatectomy. Completely normal voiding occurred in 108 of the 159 patients. Stress incontinence but no need for an incontinence device occurred in 31 patients. Improved methods for preoperative staging of the disease give promise for even higher cure rates in the future.
The direct effect of ultrasound upon Wilms' tumor in the rat.
The possible activation of immunologic defenses against tumor by local ultrasonic irradiation was investigated. Sonication of one tumor of a dual implant destroyed that tumor only with no contralateral effect. Injection of tumor cells previously sonicated in vivo did not induced immunity to subsequent challenge with live cells. Immunofluorescent staining of host kidneys for antibody complexes was negative. It was concluded that sonication was only effective when directly applied to the tumor.
President Kennedy's spine hit by first bullet.
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Interaction of ultrasound with neoplastic tissue. II. Systemic effects after local sonic irradiation.
Local sonic irradiation was applied to subcutaneously implanted Furth-Columbia rat Wilms' tumor. The weight and the rate of tritiated thymidine uptake were measured in host organs distal to the application field. Kidney and spleen weights were inhibited by the Wilms' tumor, and sonication of the tumor removed all or part of this inhibition. Liver weight was increased after sonication of tumor-bearing rats but not in nontumor-bearing rats. This may have been a response to tumor-specific substances released into the circulation by sonic destruction of tumor tissue. The adrenals enlarged as a response to the stresses of both tumor-bearing and of sonication. Animals were implanted on both sides with the Wilms' tumor and on without any break in the growth curve while the sonicated right tumor was inhibited. These data suggest that the therapeutic effect of ultrasound is due solely to local factors and that systemic sequelae of some irradiation are unrelated to tumor inhibition.
The acute need for the collection of data about urology.
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The friendly urologist: a philosophy for urology.
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Management of urinary incontinence with electronic stimulation: observations and results.
The evolution in the management of urinary incontinence with electronic stimulation of the pelvic floor is reviewed. The effect of stimulation is analyzed. Our methods of candidate screening and the contraindications to treatment are discussed. Forty patients were treated for 2 to 15 months. Sixteen patients were post-prostatectomy, 4 had stress incontinence, 4 had upper motor neuron lesions, 1 was incontinent after repair of a rectovesical fistula and 15 were post-bladder exstrophy closure. The success rate in the first group was 45.4 per cent, in the second group 100 per cent, in the third group 50 per cent, in the fourth group 100 per cent and in the fifth group 27.2 per cent. In view of the method having been tried on cases resistant to other forms of treatment the results were encouraging. The most satisfying results were in the post-exstrophy group in which no response was expected.
Carcinoembryonic antigen and bladder carcinoma.
The 24-hour urinary carcinoembryonic antigen determinations were performed on 61 patients with different stages of bladder carcinoma. Elevated titers were found in 81 per cent of the patients with active tumors and falsely positive studies were found in 7 per cent. High stage lesions were found to have high carcinoembryonic antigen levels. Plasma carcinoembryonic antigen determinations were elevated in only 45 per cent of the patients with active tumors but further study may be warranted in advanced bladder cancer cases. The 24-hour urinary carcinoembryonic antigen measurements yield the highest percentage elevations in bladder carcinoma and further investigation is required to better define its clinical application.
Long-term assessment of genital reconstruction in female pseudohermaphrodites.
The cases involving 32 women who had undergone early revision of ambiguous genitalia were reviewed 5 to 22 years postoperatively. Seven clitoridectomies, 25 clitoral recessions, 17 Y-V introitoplasties and 10 midline episiotomies were performed. There were 16 patients available for followup. The results of clitoral recessions were cosmetically and functionally satisfactory. Introital revisions done before puberty all required further revision and suggested that vaginoplasty should be deferred until after puberty.
A murine Wilms' tumor as a model for chemotherapy and radiotherapy.
We studied the effect on tumor volumes and host survival of twenty-four chemotherapeutic and radiotherapeutic regimens in rats bearing the Furth/Columbia murine Wilms' tumor. After 5 years and some 100 transfers, this tumor retained its sensitivity to suitable combinations of actinomycin D, vincristine, and X-ray, regimens in current use in the treatment of human Wilms' tumor. Cytoxan alone was highly inhibitory; adriamycin was modestly inhibitory; and lethal doses of methotrexate followed by leucovorin "rescue" were slightly inhibitory to the growth of the rat tumor. No other chemotherapeutic agent tested was effective by our criteria. Cytoxan, with or without adriamycin, and X-irradiation, were the most useful combinations studied. The chemotherapeutic agents given 3 days before irradiation were significantly more carcinostatic than they were when given after radiotherapy.