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Biomedical subjects

R G Middleton

Publications and source records attributed to R G Middleton.

At least 55 records · Page 3Linked to original sources
PubMed1987

A 15-year followup of a nonmicrosurgical technique for vasovasostomy.

A 15-year followup was summarized for patients who had nonmicrosurgical vasectomy reversal. Over-all pregnancy rates were 45 per cent (43 per cent for the first 8 years and 49 per cent for the next 7 years) and 73 per cent of the pregnancies occurred within 1 year after vasectomy reversal. Patients who achieved pregnancy compared to those who did not had significantly better sperm motility and a lower incidence of antisperm antibodies. The data indicate that nonmicrosurgical techniques can be used successfully to reverse vasectomy more economically and more rapidly than the microsurgical approach, while contributing to a reasonable pregnancy rate.

Female↗
PubMed1986

A simple and effective technique for increasing pregnancy rates in couples with retrograde ejaculation.

Seven of 12 patients with retrograde ejaculation, who had at least occasional samples with reasonable sperm numbers and motility, underwent a protocol including luteinizing hormone-timed, intrauterine insemination with washed sperm recovered from the urine. Seven pregnancies have occurred to date in six patients; the one other patient is still early in the protocol period. The described technique for collecting sperm, ovulation timing, sperm recovery, and washing and intrauterine insemination are relatively simple and cost-effective and appear to be effective in contributing to pregnancies in many couples with retrograde ejaculation.

Ejaculation↗
PubMed1986

Patient survival and local recurrence rate following radical prostatectomy for prostatic carcinoma.

From 1970 to 1980, 153 patients with stages A2, B1 and B2 prostatic cancer and proved negative pelvic lymph nodes underwent radical prostatectomy (84 underwent radical perineal and 69 underwent radical retropubic prostatectomy). Seventeen patients were lost to followup. Of 136 patients who were followed for 5 years or until death 128 (94 per cent) were alive at 5 years, including 118 (87 per cent) who were without evidence of recurrence. Patients with microscopic invasion of the prostatic capsule have a better outcome at 5 years than those with microscopic involvement of the seminal vesicles. Only 46 of the patients could be assessed at 10 years or had died 6 to 10 years postoperatively. Results at 10 years are considered preliminary, since many more patients will reach the 10-year milestone within the next few years.

Follow-Up Studies↗
PubMed1986

The Young-Dees operation for the correction of retrograde ejaculation.

Retrograde ejaculation can be a significant problem when it interferes with fertility. Sympathomimetic drugs and sperm retrieval from the urine with insemination of the wife are the common methods of treatment. When these methods have not been successful we have used the Young-Dees type of bladder neck reconstruction to convert retrograde ejaculation into normal or antegrade ejaculation. The operation has been successful in 4 of 5 patients.

Adolescent↗
PubMed1986

Modern concepts in the diagnosis and treatment of male infertility.

The use of modern techniques to manipulate sperm has assisted many couples in their effort to achieve pregnancy. Use of the techniques is dependent upon adequate and complete diagnostic data to determine if the techniques would be beneficial for a particular couple. The participation of a urologist in these techniques can take many forms but should be active to assure the best treatment for the male patient with fertility difficulties and to prepare the sperm with the available techniques prior to use for insemination or in-vitro fertilization. The future looks exciting and is sure to bring many more new developments that will benefit couples with fertility problems.

Animals↗
PubMed1985

Implications of volume of nodal metastasis in patients with adenocarcinoma of the prostate.

We divided 73 cases of pelvic nodal metastases from prostatic cancer into subgroups based upon the volume and extent of nodal disease. Of the patients with gross nodal disease 15 per cent survived 5 years without progression compared to 27 per cent of those with microscopic involvement of more than 1 node and 44 per cent with a single positive node. On the other hand, 52 per cent of the patients with gross disease died of prostatic cancer within 5 years compared to 37 per cent of those with multiple microscopic nodes and 28 per cent with a single node. Although other variables also influence prognosis, the differences in survival demonstrable within these subgroups may have important implications regarding selection of therapy and interpretation of treatment results.

Adenocarcinoma↗
PubMed1985

Pubectomy in urological surgery.

Pubectomy has been useful, particularly for the treatment of traumatic disruption of the deep urethra after a preliminary cystostomy. This procedure provides unparalleled exposure for mobilization of the apex of the prostate and distal urethral segment, and the accomplishment of an end-to-end anastomosis. Results have been good. Pubectomy has been helpful in selected cases of chronic osteitis pubis. Experience with the technique was helpful during radical pubectomy in 2 patients with chondrosarcoma of the pubis.

Adult↗
PubMed1984

Transphenoidal hypophysectomy in the management of carcinoma of the prostate.

Fifteen consecutive patients with progressive metastatic prostate cancer who had failed primary endocrine therapy underwent surgical pituitary ablation by transphenoidal hypophysectomy. Eleven patients showed subjective improvement with reduced pain postoperatively. No patient had any evidence of an objective response although duration of survival was longer in subjective responders (15 months) than nonresponders (4 months). Neither the quality nor the duration of the initial endocrine-induced remission predicted the subsequent response to hypophysectomy. The lack of objective improvement in these patients suggests that the subjective responses seen in prostate cancer patients after hypophysectomy may be due to alterations in pain receptive mechanisms rather than to a favorable impact on the disease process itself.

Adult↗
PubMed1984

Impact of external irradiation on local symptoms and survival free of disease in patients with pelvic lymph node metastasis from adenocarcinoma of the prostate.

Sixty-four patients with adenocarcinoma of the prostate and histologic evidence of pelvic nodal metastasis have been followed for at least 5 years after pelvic lymphadenectomy only. Forty-seven patients were treated with extended field irradiation, while 17 did not receive any irradiation. Only 17 per cent of the patients receiving irradiation survived free of disease for 5 years, while 40 per cent died of prostatic cancer, compared to 29 and 35 per cent, respectively, of those who did not receive irradiation. Symptomatic manifestations of local disease occurred within 5 years in 65 per cent of the patients not treated with irradiation, compared to 51 per cent of those who received pelvic irradiation. External radiation therapy imparted no discernible benefit in terms of survival free of disease in our patients. Furthermore, the impact of irradiation in preventing local symptoms in these patients seems to be slight.

Adenocarcinoma↗
PubMed1983

Accuracy of staging in A1 carcinoma of the prostate.

The classification of patients with incidental carcinoma of the prostate into focal (Stage A1) or diffuse (Stage A2) subgroups depends primarily on the microscopic findings on tissue removed from transurethral resection (TUR) or open enucleation. However, these procedures sample only a portion of the entire prostate, and some patients staged A1 may have residual diffuse cancer that should properly be classified as Stage A2. This study is a review of 86 patients with Stage A1 cancer of the prostate in whom additional prostatic tissue was available because of repeat transurethral resection or radical prostatectomy. Only six patients (7%) were found to have diffuse cancer in the remaining prostatic tissue. Therefore, it appears that the classification of patients into Stage A1 or Stage A2 is generally accurate when based on the findings from initial TUR alone and that the incidence of understaging in this group is low. Repeat transurethral resection does not appear to contribute significantly to the accuracy of staging.

Carcinoma↗
PubMed1983

Penetration of zona-free hamster ova and bovine cervical mucus by fresh and frozen human spermatozoa.

Semen samples from 25 fertile donors and 34 infertility patients were analyzed and evaluated both fresh and frozen with the zona-free hamster egg penetration test (EPT) and the bovine cervical mucus penetration test (MPT). Cryopreserved sperm penetrated 47.2% (average) of the hamster eggs, and fresh sperm penetrated 55.9%. Frozen sperm retained 86% of the fresh EPT values (P, not significant), but only 38% of the fresh MPT values (P less than 0.001). Cryopreserved sperm yielded the same fertility classification as fresh sperm in 94% of the cases with the EPT but only 43% with the MPT. The use of cryopreserved sperm simplifies the procedure and should enable more laboratories to utilize the EPT, but the poor results with the MPT preclude utilization of cryopreserved sperm for routine fertility evaluation with the MPT.

Animals↗
PubMed1983

The effect of single-density bovine serum albumin columns on sperm concentration, motility, and morphology.

Experiments were conducted to determine whether single-density albumin columns could be used to improve sperm motility and morphology. Semen samples from 92 men seen at a fertility evaluation clinic were analyzed for count, motility, and morphology and centrifuged. An aliquot of the resuspended sample was then layered on top of 1 ml of a 7.5% solution of bovine serum albumin (BSA). Another aliquot was layered on top of a 10% BSA column. After 60 minutes, the sperm penetrating the bottom two thirds of the albumin layer were isolated and analyzed for count, motility, and morphology. The sperm count after exposure to both 7.5% and 10% BSA columns decreased to approximately 60% of the preisolation counts. Sperm motility was not altered by column separation at either albumin concentration, but sperm morphology significantly improved with both columns. The single-density albumin separation technique therefore improved morphology and had no effect on motility, and a reasonable number of sperm were retained after separation. Albumin separation techniques could be utilized to improve samples with morphology defects before use with artificial insemination or in vitro fertilization. It is uncertain whether this procedure would result in a higher pregnancy rate.

Adult↗
PubMed1983

Pelvic lymph node metastasis from prostatic cancer: influence of tumor grade and stage in 452 consecutive patients.

During the last decade 452 patients have undergone pelvic lymphadenectomy as a staging procedure for apparently localized prostatic cancer. Of these patients 105 (23 per cent) had pelvic node metastasis. Node involvement occurred in no patient with a stage A1, 24 per cent with stage A2, 12 per cent with stage B1, 28 per cent with stage B2 and 53 per cent with stage C tumor. Correlation with tumor grade revealed nodal metastasis in 10 per cent of the patients with well differentiated tumors, 24 per cent with moderately differentiated lesions and 54 per cent with poorly differentiated tumors. The incidence of positive nodes is low enough to preclude lymphadenectomy in patients with stage A1 (0 per cent) and well differentiated stage B1 tumors (4 per cent), and high enough to assume metastatic disease without lymphadenectomy in those with poorly differentiated stage C tumors (93 per cent). All other patients with apparently localized prostatic cancer should undergo a staging pelvic node dissection before definitive treatment.

Adult↗
PubMed1983

Surgical treatment of stage A2 prostatic carcinoma: significance of tumor grade and extent.

Patients with stage A2 carcinoma of the prostate are a heterogeneous population and not all of them progress to clinically manifest disease. We found a similar variability in terms of the pathological findings in a group of 34 patients with stage A2 disease undergoing pelvic lymphadenectomy and radical prostatectomy. While 8 patients (24 per cent) had metastatic disease on staging lymphadenectomy, 9 patients (27 per cent) had negative lymphadenectomy, with minimal or no residual tumor in the radical specimen. The histologic grade and extent of tumor on transurethral resection did not predict reliably patients with stage A2 disease and minimally invasive cancer at radical prostatectomy. It appears that present criteria for separating stage A tumors into focal and diffuse categories are adequate for selecting therapy for patients with incidental carcinoma of the prostate.

Adenocarcinoma↗
PubMed1983

Bladder carcinosarcoma: histologic variation in metastatic lesions.

Carcinosarcoma is a tumor composed of malignant epithelial and mesenchymal elements, which occurs rarely in the bladder. Although the prognosis of bladder carcinosarcoma is known to be poor the histology of metastatic lesions is not well described. We report 2 cases of bladder carcinosarcoma with pelvic lymph node involvement. Pure sarcomatous metastasis was present in 1 patient and only carcinoma in the other. The histologic composition of metastatic lesions may be of significance in treatment planning in patients with bladder carcinosarcoma.

Aged↗
PubMed1983

Radical prostatectomy for localized prostate cancer.

Radical prostatectomy is a proven and successful operation that can be curative for localized prostatic cancer. With advances in staging methods and attention to the grading of prostatic tumors, there is good reason to believe that radical prostatectomy will have and should have an expanded role in the treatment of prostatic cancer. Overconcern with potential complications from this operation is no longer justified.

Humans↗