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Biomedical subjects

R E Stutzman

Publications and source records attributed to R E Stutzman.

At least 37 records · Page 2Linked to original sources
PubMed1982

Commercial radioimmunoassay for beta subunit of human chorionic gonadotropin: falsely positive determinations due to elevated serum luteinizing hormone.

Among 17 men who had received seemingly curative treatment for unilateral non-seminomatous germ cell tumors for the testis and who had consistently normal serum human chorionic gonadotropin (HCG) levels at a reference laboratory, 7 (41%) had at least one falsely positive commercial serum HCG determination. To investigate the cause of these falsely positive determinations the authors measured the cross reactivity of luteinizing hormone (LH) and follicle stimulating hormone (FSH) standards in the commercial HCG assay, and studied the relationship between commercial HCG levels and serum LH levels, serum FSH levels and gonadal status in men with and without normal gonadal function. The falsely positive HCG determinations appeared to be due to elevated serum LH levels and cross reactivity of LH in the commercial HCG assay because: 1) there was substantial cross reactivity of the LH standards in the commercial assay, 2) the serum LH was elevated in four of six men with solitary testes, 3) there was a striking correlation between elevated serum LH levels and falsely elevated commercial HCG levels in ten men with solitary or absent testes, and 4) there were no falsely positive HCG determinations in 13 normal men but there were falsely positive HCG determinations in seven of ten anorchid men.

Adolescent↗
PubMed1981

Treatment experience with nonseminomatous testicular cancer in patients with stage II and stage III disease.

Thirty-eight patients with nonseminomatous testicular cancer were treated with cis-platinum, bleomycin, and vinblastine in combination without a prolonged maintenance phase. Twenty-Six patients with Stage III disease were treated. Seventy-six percent of those patients treated achieved complete remission. At a median survival time of 30 months, no patient who achieved a complete remission has relapsed. Twelve Stage II patients given adjuvant therapy remain free of disease at a median time of 23 months. Markedly elevated serum lactate dehydrogenase levels and massive disease were common findings in the patients who did not achieve complete remission. One drug death occurred secondary to sepsis. Symptoms of depression and anxiety were significant dose-limiting factors in this group of patients.

Adolescent↗
PubMed1981

Radiation therapy for nonseminomatous germ cell tumors of the testis: a reappraisal.

We analyzed the efficacy of radiation therapy and retroperitoneal lymphadenectomy preceded and followed by radiation therapy as curative treatment in 113 patients with clinical stages I and II nonseminomatous germ cell tumors of the testis. Radiation therapy alone was curative in 86 and 82 per cent of the patients with clinical stages I and II disease, respectively, and radiation therapy before and after retroperitoneal lymphadenectomy was curative in 89 and 73 per cent of patients with clinical stages I and II disease, respectively. Of 26 patients with clinical stage II disease in the group receiving radiation therapy before and after retroperitoneal lymphadenectomy only 13 (50 per cent) had pathologic documentation of retroperitoneal metastasis or histologic evidence of nodal metastases that had been destroyed by radiation therapy alone. When analyzed by pathologic stage radiation therapy before and after retroperitoneal lymphadenectomy was curative in 91 and 51 per cent of patients with stage I and II disease, respectively. In our series clinical overstaging may have been responsible for the favorable results of radiation therapy alone, and radiation before and after retroperitoneal lymphadenectomy in the treatment of clinical stage II nonseminomatous germ cell tumors.

Adolescent↗
PubMed1981

Radical prostatectomy with pelvic lymphadenectomy: observations on the accuracy of staging with lymph node frozen sections.

The accuracy of intraoperative frozen section examination of excised lymph nodes was analyzed in 40 consecutive patients with clinical stages A2, B1 and B2 adenocarcinoma of the prostate who underwent pelvic lymphadenectomy immediately before anticipated radical prostatectomy. Lymph node metastases were observed with frozen sections and verified with paraffin sections in 5 cases (13 per cent). Among the 35 patients with negative frozen sections lymph node metastases were found with paraffin sections in 3 cases (9 per cent). Despite the potential for false negative findings we believe that intraoperative frozen sections constitute a practical method of pathologic staging prior to radical prostatectomy.

Adenocarcinoma↗
PubMed1981

A comparison of testicular tumors in black and white patients.

Testicular tumors are uncommon in black compared to white patients but several reports have indicated that this disease is more lethal in black patients. We reviewed the records of 840 post-puberal patients with primary tumors of the testis seen between 1949 and 1979. There were 17 black and 823 white patients. The predominant tumor in both groups of patients was seminmona. Ten black (58.5 per cent) and 329 white patients (29 per cent) had a non-seminomatous germ cell testicular tumor, while 494 white patients (60 per cent) had such a tumor. These observations alone suggest an over-all better prognosis in black than in white patients. The data demonstrate again the rarity of this disease black patients but our survey shows that black patients with testicular tumors have a better prognosis than has been reported previously.

Black People↗
PubMed1980

Experience with serum alpha-fetoprotein and human chorionic gonadotropin in non-seminomatous testicular tumors.

Serum levels of alpha-fetoprotein and human chorionic gonadotropin were used in the management of 50 consecutive patients with non-seminomatous germ cell tumors of the testis. Of the 50 patients 36 had clinical or pathologic documentation of malignancy at some time during their treatment and 34 of these patients (94 per cent) had elevated levels of 1 or both of the markers. The marker(s) was elevated before lymphadenectomy in 9 of 15 patients (60 per cent) with clinical stage A or B disease wh had not been cured by orchiectomy. Among patients with pathologic stage B disease elevated marker levels before or after lymphadenectomy were of no prognostic significance. All of the patients with stage C disease had elevated marker(s) and the effectiveness of chemotherapy in destroying measurable disease generally was reflected in the marker levels.

Adolescent↗
PubMed1980

The liver scan in urologic oncology.

The predictive value of liver scans for the detection of hepatic metastases is discussed. A retrospective review was done on 104 patients with urologic malignancies who had undergone liver scans and liver function tests. Liver scans had a low predictive value, while serum alkaline phosphatase alone had a higher predictive value. The combination of low predictive value and high cost/benefit ratio indicates that the liver scan has no routine role in the urologic oncologic staging.

Alkaline Phosphatase↗
PubMed1980

Radiation therapy: a primary treatment modality for seminoma.

It would appear that: (1) Seminomas are radiosensitive neoplasms. (2) Patients with stage I seminoma, including anaplastic seminoma, should receive radiation therapy to the para-aortic and ipsilateral pelvic and inguinal nodes. (3) Most patients with stage II seminoma (including anaplastic seminoma) with negative human chorionic gonadotropin results also respond well to radiation therapy that includes the mediastinum and appropriate supraclavicular area. However, surgery and chemotherapy are indicated in patients with bulky stage II disease and in those patients with persistent elevation of postorchiectomy human chorionic gonadotropin. (4) Patients with stage III seminoma should receive chemotherapy initially. (5) Serum tumor markers may be a major diagnostic and staging modality in seminoma, as patients with an elevated alpha-fetoprotein (AFP), before or after orchiectomy, demonstrate evidence of a nonseminomatous germ cell neoplasm and should be treated accordingly despite the lack of histologic confirmation in the testicular tissue. Approximately 10 per cent of patients with seminoma will have an elevated level of human chorionic gonadotropin. The clinical significance of this finding requires further study.

Chorionic Gonadotropin↗
PubMed1979

Vasectomy with transurethral resection of prostate.

A retrospective study was made of 200 patients undergoing transurethral prostatectomy. Half of these patients received bilateral vasectomies. The vasectomized patients had a 5-percent incidence of epididymitis as compared with a 2-percent incidence in the nonvasectomized patients. Vasectomy failed to provide adequate protection against postoperative epididymitis and cannot be recommended as a routine procedure with a transurethral prostatectomy.

Epididymitis↗
PubMed1979

Complications of retroperitoneal lymphadenectomy for nonseminomatous tumors of testis.

We present 4 patients with serious complications after retroperitoneal lymphadenectomy. Chylothorax developed in the first patient; hypertension, blindness, and paralysis of the lower extremities in the second; volvulus and necrosis around an adhesion in the right upper quadrant in the third; and small-bowel obstruction and radiation myelitis in the fourth patient. These complications and modes of treatment and prevention are discussed.

Adult↗
PubMed1979

Critical appraisal of routine supraclavicular lymph node biopsy in staging of testicular tumors.

Supraclavicular lymph node biopsy was performed as a staging procedure in 36 patients with germ cell tumors of the testis and nonpalpable supraclavicular nodes. Of 28 patients with clinical Stage A or B disease, 1 patient (4 per cent) was found to have supraclavicular metastases. Of 8 patients with clinical Stage C disease, 2 (25 per cent) had supraclavicular metastases. The apparent infrequency with which subclinical supradiaphragmatic disease is documented with this procedure and the current use of adjuvant systemic therapy in patients with pathologic Stage B nonseminomatous tumors suggest that supraclavicular lymph node biopsy should be abandoned as a routine staging procedure.

Adolescent↗
PubMed1979

Anterior bladder tube flap reconstruction of the urethrovesical neck after radical retropubic prostatectomy.

Difficulty with urethrovesical neck anastomosis after radical retropubic prostatectomy led us to form an anterior bladder tube flap for anastomosis to the transected urethra in 5 selected cases. We found that combining the anterior bladder tube flap technique with radical retropubic prostatectomy facilitates the urethrovesical neck anastomosis and improves the transient postoperative incontinence sometimes encountered. Results of the 5 patients in whom this technique was used form the basis for a brief discussion of the technique.

Aged↗
PubMed1979

Prostatic acid phosphatase by radioimmunoassay tumor marker in bone marrow.

Bone marrow acid phosphatase was determined by radioimmunoassay and enzymatic analysis in 95 patients with benign prostatic hypertrophy, 50 patients with disseminated prostatic carcinoma and 36 patients with non-prostatic malignancy. The results indicate superior specificity of the radioimmunoassay. A brief review of the topic and the clinical implications are discussed.

Acid Phosphatase↗
PubMed1979

Experimental penetrating renal trauma: a comparison of bench and in situ repair.

Penetrating renal trauma often requires total nephrectomy. To minimize this high rate of renal loss, extracorporeal (bench) surgery, already an accepted method for treating renovascular and renal tumor, might be used in patients with parenchymal injuries to provide a more meticulous repair and improved renal function. To compare the effectiveness of this technique with that of in situ repair, 32 dogs were divided into two equal groups. They all received a standardized injury to the renal parenchyma. Contralateral nephrectomy was performed. Renal function was evaluated for 21 days. Serum creatinine values were comparable in the two groups. Bench repair offered excellent results but not better than in situ repair for parenchymal and collecting system injuries.

Animals↗
PubMed1978

Plasma testosterone in patients receiving diethylstilbestrol.

With accurate, inexpensive plasma testosterone assays now available it is possible to monitor the efficacy of hormonal manipulation in the patient with adenocarcinoma of the prostate. We monitored plasma testosterone in our patients receiving diethylstilbestrol (DES) 1 mg. per day. We found no statistical difference in mean plasma testosterone between patients with adenocarcinoma of the prostate and castrated patients with prostatic carcinoma, all receiving DES, 1 mg. per day. We recommend that plasma testosterone be closely monitored in patients receiving hormonal therapy for adenocarcinoma of the prostate.

Adenocarcinoma↗
PubMed1978

Vasoseminal vesiculography in staging adenocarcinoma of prostate.

We found vasoseminal vesiculography useful in staging adenocarcinoma of the prostate and in measurement of radiotherapy ports. In 12 patients who had radical prostatectomies, the histologic findings correlated well with the vasoseminal vesiculograms. Criteria for reading benign prostatic hyperplasia and prostatic carcinoma have been well established in the literature and are reviewed.

Adenocarcinoma↗
PubMed1978

Latent residual tumor following external radiotherapy for prostate adenocarcinoma.

Fifty patients with adenocarcinoma of the prostate were treated by external supervoltage radiotherapy. Needle biopsies were obtained at timed intervals after completion of therapy. Six of 17 patients with stages A and B disease and 15 of 33 patients with stage C disease had positive biopsies. In patients biopsied more than 18 months after therapy 15 of 29 (52 per cent) had residual tumors. Of 17 patients biopsied 36 months or more after therapy 10 (59 per cent) had residual tumor. These results suggest that patients with residual tumor 18 months after therapy will not have resolution of the tumor at a future date and represent treatment failure.

Adenocarcinoma↗