Search PubMed⌕ Search

Biomedical subjects

R G Rowland

Publications and source records attributed to R G Rowland.

At least 55 records · Page 3Linked to original sources
PubMed1994

Complications of primary retroperitoneal lymph node dissection.

The surgical morbidity in 478 patients who underwent primary retroperitoneal lymphadenectomy for clinical stages I and II nonseminomatous testicular cancer from 1982 to 1992 was reviewed. There were 54 complications in 51 patients (10.6%) and no operative related mortality. Superficial wound infection was the most frequent complication, comprising 45% of the total number of complications. Most major complications were related to small bowel obstruction and atelectasis. No complications caused permanent disability. The complication rate was less in patients who underwent a modified unilateral procedure (9.4%) than in those who underwent bilateral dissection (19.3%). Complications were significantly less with procedures done during the latter 6 years of the study (1987 to 1992). The ejaculation rate of patients undergoing a nerve sparing procedure was 98%, which reflects the increase in experience gained with the technique of nerve sparing modified unilateral dissection for early stage testicular cancer. This study reinforces the view that primary retroperitoneal lymph node dissection is an operation with minimal morbidity and no long-term effects. Furthermore, this study serves as the basis for cost-benefit and risk-benefit analyses of primary retroperitoneal lymph node dissection in low stage testicular cancer, which can be set against surveillance and primary chemotherapy programs.

Humans↗
PubMed1993

Management of chylous ascites after retroperitoneal lymph node dissection for testicular cancer.

Iatrogenic ascites is an uncommon complication of surgery of the retroperitoneum, the base of the mesentery or mediastinum. We treated 18 patients with chylous ascites occurring after retroperitoneal dissection for testicular cancer. Patients were diagnosed by paracentesis or on clinical grounds (increasing abdominal girth). Of interest, 6 patients underwent resection of the inferior vena cava as part of the procedure, and this appears to be a high risk group for this complication. Management options include dietary restriction of fat, administration of medium chain triglycerides and diuretics, hyperalimentation, peritoneovenous shunt or surgery. The majority of patients were managed successfully by dietary treatment.

Adolescent↗
PubMed1993

Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965 to 1989): modifications of technique and impact on ejaculation.

Results with primary retroperitoneal lymphadenectomy in 464 patients with clinical stage A nonseminomatous germ cell testis cancer (1965 to 1989) were reviewed. The false-negative staging error by clinical methods remains at 30%. The relapse rate in pathological stage A cancer patients was 11% (37 of 323), with 2 deaths. For pathological stage B disease 64% of the patients were cured by retroperitoneal lymphadenectomy alone. With modern adjuvant chemotherapy no stage B tumor relapsed since 1979 and the survival rate was 100%. For all 25 years (464 patients) the relapse rate was 14% and the survival rate was 98.9% (3 cancer and 2 noncancer deaths). Because these results are based on preoperative clinical staging, they are directly comparable with series using radiotherapy or surveillance.

Adolescent↗
PubMed1993

Primary retroperitoneal lymph node dissection in clinical stage A non-seminomatous germ cell testis cancer. Review of the Indiana University experience 1965-1989.

The results of primary retroperitoneal lymph node dissection (RPLND) in 464 patients with clinical stage A non-seminomatous germ cell (NSGC) testis cancer treated over 25 years (1965-1989) were reviewed. The results were analysed in clinical terms and subdivided into early (1965-1978) and contemporary (1979-1989) groups in order to be comparable with series using radiotherapy or surveillance. Between 1965 and 1978 (86 clinical stage A patients) the overall relapse rate of 15% (n = 13) was similar to that of radiotherapy series but survival (97.7% after RPLND) was superior to that achieved with irradiation (87%). From 1979 to 1989, 378 clinical stage A patients had primary RPLND and 30% of them (n = 112) had cancerous nodes. The relapse rate for pathological stage A (n = 266) was 12% and 2 patients died. The relapse rate in pathological stage B patients without adjuvant chemotherapy was 34%. No relapse was seen among 48 pathological stage B patients who received post-operative adjuvant chemotherapy. The death rate was 0.8% among 378 clinical stage A RPLND patients. While not statistically significantly different from death rates reported in current surveillance series, these consistent results spanning 2 eras (before and after cisplatin) over 25 years suggest a sound basis for the surgical approach. The anatomical and medical principles in oncology, which have supported this approach, still remain cogent today. Now that nerve-sparing techniques have been developed, the only long-term morbidity of RPLND (anejaculation) has been avoided. It would seem appropriate to include nerve-sparing RPLND techniques in the management of clinical stage A disease.

Adolescent↗
PubMed1992

Prognosis and other clinical correlates of pathologic review in stage I and II testicular carcinoma: a report from the Testicular Cancer Intergroup Study.

PURPOSE: The Testicular Cancer Intergroup Study (TCIS) was undertaken to evaluate the pathologic findings in early-stage testicular cancer as determined by central pathology review, to compare these findings with the interpretation by the contributing pathologists, and to make correlations with various clinical parameters and outcomes. PATIENTS AND METHODS: The prospective study of non-seminomatous germ cell testicular cancer staged surgically involved 459 eligible patients with stage I (node-negative) or stage II (node-positive) disease. Pathologic materials from both the orchiectomy and lymphadenectomy specimens were submitted to a central laboratory for evaluation. RESULTS: Central and local pathologists differed significantly in their identification of certain cellular histologies (primarily yolk sac tumors [YST]) and recognition of invasion into vascular structures. In contrast to our prior findings with local pathologic assessment, venous/lymphatic invasion as determined by central review predicted relapse in both stages. In pathologic stage I disease, the relapse rate was 19.4% (12 of 62 cases) for those with invasion versus 6.0% (10 of 168 cases) for those without invasion. In pathologic stage II disease, the respective relapse rates were 63.5% (40 of 63 cases) and 24.0% (six of 25 cases). Vascular invasion was jointly predictive with nodal stage for risk of relapse. The percentage of embryonal carcinoma (EC) in the primary tumor was predictive of nodal stage and relapse in a univariate, but not a multivariate, analysis. In a large substudy, immunohistochemical staining identified a correlation between stain intensity in YST and serum alpha-fetoprotein (AFP) levels. In a similar fashion human chorionic gonadotropin (HCG) staining reactivity occurred exclusively in patients with syncytiotrophoblasts and correlated with serum levels of beta-HCG. CONCLUSIONS: A number of tumor histology correlates with clinical parameters have been identified or confirmed. Careful pathologic scrutiny of the primary testicular tumor, especially for vascular invasion, provides important prognostic information.

Adolescent↗
PubMed1991

Resection of the inferior vena cava or intraluminal vena caval tumor thrombectomy during retroperitoneal lymph node dissection for metastatic germ cell cancer: indications and results.

A total of 42 patients underwent inferior vena caval resection (40) or intraluminal tumor thrombectomy (2) during retroperitoneal lymph node dissection for bulky abdominal metastatic nonseminomatous germ cell cancer (7% of all post-chemotherapy retroperitoneal lymph node dissection cases). The 3 indications for vena caval resection included tumor clearance (38%), vena caval scar occlusion (14%) and vena caval tumor thrombus (48%). En bloc vena caval resection to achieve tumor clearance was justified by subsequent nodal pathology (cancer in 63% of the specimens and teratoma in 31%). Vena caval resection in the presence of scar occlusion was de facto required by virtue of its incorporation in the specimen. Vena caval resection or thrombectomy is indicated for intraluminal tumor thrombus because thrombus pathology (cancer 35%, teratoma 45% and fibrosis 20%) reflected nodal pathology in 71% of the patients with cancer, 78% with teratoma and 100% with fibrosis. The complications of vena caval resection were generally transitory. The 71% survival rate justifies this intensive surgical approach because these patients had exhausted all chemotherapy options.

Adolescent↗
PubMed1990

Nerve-sparing retroperitoneal lymphadenectomy with preservation of ejaculation.

The feasibility of sparing postganglionic fibers of lumbar sympathetic nerves during the course of retroperitoneal lymphadenectomy has been investigated at our university medical center beginning in 1978. We selected 75 patients for nerve-sparing retroperitoneal lymphadenectomy in an effort to preserve ejaculatory function postoperatively. This cohort of patients was selected on the basis of clinical stage. Of the 75 patients 73 had clinical stage I disease. However, 14 of these 73 patients had pathological stage II cancer. No patient was treated with adjuvant chemotherapy after nerve-sparing retroperitoneal lymphadenectomy. Of these 14 patients with pathological stage II disease 4 had relapse: 1 with proved retroperitoneal recurrence, and 3 with serological elevations of tumor markers and questionable clinical findings as to anatomical site of relapse. All 4 patients are free of disease after chemotherapy and/or surgical (1) rescue. There were no local recurrences in the 61 patients with negative nodes. All 75 patients ejaculate and had no evidence of disease more than 2 years after nerve-sparing retroperitoneal lymphadenectomy. It is clear that nerve-sparing retroperitoneal lymphadenectomy is a feasible technique. As noted, it can even be applied to selected patients with low volume positive nodes, yet maintaining relapse and survival figures that are acceptable. Ejaculation is reliably preserved when this nerve-sparing technique is applied accurately in retroperitoneal lymphadenectomy.

Adrenergic Fibers↗
PubMed1988

Continent urinary reservoirs.

Public awareness of the alternatives to wet stomas and the patient's concern for body image have significantly increased the demand for continent urinary reservoirs. In the final analysis, preservation of renal function is the standard for judging the success of a diversion, and long-term observations must be made with this point in mind. It seems likely that the continent reservoirs now available will preserve renal function.

Cecum↗
PubMed1988

Testicular germ-cell neoplasms: curative approaches.

Approximately 80 per cent of all patients with testis cancer will present with low-volume disease. If they are pathologic stage I, there is virtually a 100 per cent cure rate even though 5 to 10 per cent will relapse after node dissection. Those who have relapsed have been salvaged with systemic chemotherapy. If clinical stage I patients are followed on observation protocols, 20 to 30 per cent of the patients will relapse. Unfortunately, a small percentage of these patients will not be salvaged with chemotherapy because they have more advanced disease at the time that the relapse is discovered. The main objection to retroperitoneal lymph node dissection in patients with low-stage disease has been the issue of infertility induced by the procedure. This problem has been alleviated by the development of the prospective nerve-sparing procedures. Long-term follow-up is still required to make certain that the relapse rate is not significantly higher than with a full retroperitoneal lymph node dissection. Experience has demonstrated that patients with stage II disease will achieve a 98 to 99 per cent cure rate regardless of whether they have adjuvant chemotherapy after surgery, or full-course chemotherapy should they relapse (approximately 50 per cent). Advanced disease is best treated initially by systemic chemotherapy. The emphasis in the last few years has been on a reduction in the toxicity of chemotherapy while maintaining the high degree of efficacy. Surgery is used as an adjunct to chemotherapy in those patients who achieve a partial remission. Careful follow-up cannot be over emphasized in patients with any form of treatment for testis cancer. It is especially important that those patients who have teratoma present in the surgical specimens obtained at the time of a postchemotherapy lymph node dissection have prolonged follow-up, because recurrences have been noted as long as 6 to 8 years after the initial event. Although primary retroperitoneal or mediastinal germ-cell tumors do exist, the vast majority arise from the testis. If the diagnosis of germ-cell tumor has been made by some means other than orchiectomy, a careful review of the patient's history and physical findings is needed to guide the physician to the possible testicular site of origin. If no physical findings are present, scrotal ultrasound may be helpful in localizing a primary tumor of the testis. If such localization is possible, then a radical orchiectomy should be performed to prevent future seeding from persistent tumor in the testicle.(ABSTRACT TRUNCATED AT 400 WORDS)

Dysgerminoma↗
PubMed1988

Serum markers in testicular germ-cell neoplasms.

At the present time, serum determinations of alpha fetoprotein and beta-HCG are the most useful markers in the management of germ-cell testis tumors. Serial determinations are vital to the monitoring of the response of the patient's tumor to therapy. Subsequent elevation of tumor markers is often the first evidence of recurrence of tumor and allows effective treatment to be instigated while the volume of recurrent tumor is extremely low. This markedly increases the likelihood of achieving complete remissions.

Biomarkers, Tumor↗
PubMed1988

Testicular cancer: innovations in diagnosis and treatment.

We are fortunate at this point in time that testicular cancer is probably the most successfully treated solid tumor. Although many diagnostic tools are available, successful diagnosis still relies on suspicion, and to a great extent, physical findings. Staging techniques have greatly improved but they still have limitations. Through advances in the treatment of disease, the toxicity of the treatment regimens and the morbidity from surgery and chemotherapy have been much reduced. Recently, advances have been made that will most likely allow the majority of patients to maintain their fertility even though they require surgical staging and perhaps chemotherapy for their disease. We are fortunate that we are truly in the time where the emphasis can be placed on finding less extensive treatments and still maintaining the high success rates that are enjoyed in the treatment of this tumor. However, one note of caution needs to be sounded, that continued long-term observation and tabulation of the results will be necessary in order to monitor the efficacy of our reduced treatment schemes.

Biomarkers, Tumor↗
PubMed1987

Tunica wedge excision to correct penile curvature associated with the inflatable penile prosthesis.

We encountered 7 cases of significant penile curvature after placement of an inflatable penile prosthesis. In 3 cases curvature was present preoperatively owing to Peyronie's disease and penile trauma, while in 4 it developed postoperatively owing to improper penile positioning. Curvature was straightened successfully by removal of small elliptical wedges of tunica albuginea of the corpus cavernosum from the convex surface of the curve and closing the defects created with 3-zero polydioxanone sutures. A subjectively gratifying result was achieved in each instance.

Adult↗
PubMed1987

Infectious complications of penile prosthetic implants.

An infectious complication involving placement of a penile prosthesis is a disastrous event. A review of more than 300 devices placed between 1979 and 1984 at this center reveals an infectious complication rate of 8.3 per cent. Perioperative risk factors predisposing to infection included reoperation for technical failures, inadequate antibiotic coverage (specifically for Staphylococcus epidermidis), failure to perform a circumcision at the time of placement in uncircumcised patients and simultaneous placement with an artificial urinary sphincter device. No group of patients nor type of prosthesis was more susceptible to the development of a postoperative infection.

Anti-Bacterial Agents↗
PubMed1987

Indiana continent urinary reservoir.

Cecoileal reservoirs were created in 29 patients. Tunneled ureteral implantations along the tenia of the cecum provided the antireflux mechanism. Plication or tapering of the terminal ileal segment along with the ileocecal valve provided the continence mechanism. The tubular configuration of the cecum was disrupted with either an ileal or sigmoid patch, or it was re-configured in a Heineke-Mikulicz type of closure to avoid bolus (unit) contractions. Short-term followup examination with excretory urography showed no upper tract obstruction. X-rays of the pouch showed no reflux and interviews revealed satisfactory continence in 93 per cent of the patients.

Adult↗
PubMed1987

Correlation of computerized tomographic changes and histological findings in 80 patients having radical retroperitoneal lymph node dissection after chemotherapy for testis cancer.

A total of 80 patients with stage B3 or B2/C germ cell testis tumors underwent computerized tomography before and after chemotherapy. The volume and computerized tomographic density of metastatic retroperitoneal tumor were measured on all scans. The patients then underwent full bilateral retroperitoneal lymphadenectomy. The change in volume and density of retroperitoneal disease was correlated with the histological type of the primary testis tumor and with the histological findings at retroperitoneal lymphadenectomy. In all 15 patients (100 per cent) without teratomatous elements in the original tumor and who had a greater than 90 per cent decrease in the volume of retroperitoneal masses as a response to systemic chemotherapy no teratoma or active cancer was found in the surgical specimen. In contrast, 7 of 9 patients (78 per cent) with teratomatous elements in the original specimen had either teratoma or carcinoma in the retroperitoneal lymphadenectomy specimens despite having a greater than 90 per cent decrease in tumor volume. This difference was significant (p less than 0.05). These data suggest that patients with no teratomatous elements in the original specimen and a greater than 90 per cent decrease in the volume of retroperitoneal masses in response to chemotherapy can be observed carefully for signs of recurrence rather than undergoing post-chemotherapy retroperitoneal lymphadenectomy.

Antineoplastic Agents↗