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Biomedical subjects

R R Pfister

Publications and source records attributed to R R Pfister.

At least 55 records · Page 3Linked to original sources
PubMed1985

Urethral duplication and complete bladder exstrophy.

Urethral duplication is a rare anomaly that has been classified into epispadiac, hypospadiac, spindle, Y-duplications and collateral varieties. We report a case of an accessory urethra associated with complete bladder exstrophy in which the accessory urethra was integrated into the epispadias repair. To our knowledge this is the first case reported of urethral duplication associated with bladder exstrophy.

Abnormalities, Multiple↗
PubMed1985

Evaluating the undescended testis.

This problem is often associated with other anomalies which, if present, are usually evident on the initial examination. Therapy before age two is mandatory to preserve fertility. The malignant potential of undescended testes is well established. Placement of the testes into the scrotum facilitates frequent examinations. All postpubertal patients with intra-abdominal testes, as well as patients who have inguinal testes and are between puberty and age 50, should be referred for orchiectomy.

Adolescent↗
PubMed1984

Stage D1 adenocarcinoma of prostate.

The natural history of Stage D1 adenocarcinoma of the prostate remains unclear. In a series of 50 patients with positive pelvic lymph nodes at the time of staging lymphadenectomy, metastatic disease developed in 43 per cent of the patients treated for cure within the period of time of follow-up. Several series from the literature confirm those findings. Positive pelvic lymph nodes most probably represent systemic disease, and the patients are incurable by current surgical and radiotherapeutic modalities.

Adenocarcinoma↗
PubMed1984

Acid phosphatase: its influence on the management of carcinoma of the prostate.

Of 343 patients who underwent pelvic lymph node dissection during treatment for carcinoma of the prostate 25 had persistently elevated serum enzymatic acid phosphatase levels preoperatively: 15 (60 per cent) had metastases to the pelvic lymph nodes and 10 (40 per cent) had negative nodes. Bone metastases occurred in 10 of 12 (83 per cent) and 5 of 7 patients (71 per cent), respectively, who were followed for a minimum of 2 years. Of the 318 patients with normal serum enzymatic phosphatase levels 70 (22 per cent) had positive nodes. A persistently elevated serum enzymatic acid phosphatase level in patients with proved carcinoma of the prostate, with elimination of infrequent causes of enzyme elevation, indicates metastases and has significant implications regarding staging and, thus, therapy of this disease.

Acid Phosphatase↗
PubMed1984

Polymorphonuclear leukocytic inhibition by citrate, other metal chelators, and trifluoperazine. Evidence to support calcium binding protein involvement.

Corneal ulceration after severe alkali burns of the eye is thought to result principally from collagen breakdown as a consequence of local polymorphonuclear leukocyte (PMN) activities. The favorable effect of topical citrate on such burns suggested a direct effect on these inflammatory cells. These in vitro studies show that the stimulation of human PMN by opsonized zymosan can be inhibited by citrate, EDTA, and EGTA. These compounds interfere with opsonized zymosan attachment to PMN, preventing the respiratory burst, phagocytosis, and degranulation. Reversal of this inhibition by calcium and/or magnesium suggests that mechanism is calcium chelation. Trifluoperazine (TFP) inhibition of opsonized zymosan attachment and phagocytosis implicates the involvement of calmodulin. We propose that citrate, EDTA, and EGTA interfere with the receptor mediated attachment of opsonized zymosan to the PMN cell membrane, leaving the PMN in a resting, granulated state. Inhibition of the receptor system by calcium depletion may be the result of interference with calcium-calmodulin modulated microfilament and/or microtubule interfaces in the PMN plasma membrane. It is postulated that comparable events occur in the citrate treated alkali burned cornea. Citrate inhibition of PMN may be useful in other eye and systemic diseases.

Burns↗
PubMed1983

Aphakic refractive penetrating keratoplasty using newborn donor corneas. A preliminary report on an alternative approach to refractive correction.

Eyes with corneal disease receiving transplants from premature, full gestational newborns or postnatal donors yield refractive results with a myopic shift. When the donor cornea is from a newborn (40-41 week gestation) this myopic shift was sufficient to correct 5 of 7 aphakic eyes to an average postsurgical refraction of -1.0 diopter (spher equiv). One premature cornea gave -6.0 diopters while six postnatal infant corneas gave an average correction of +8.6 diopters (spher equiv). The steep corneal curvature resulting from surgery explains the additional refractive power noted. The surgical difficulties encountered and the unknown long-term results auger for a slow and controlled introduction of this concept into our everyday practices.

Aphakia↗
PubMed1983

The effects of chemical injury on the ocular surface.

Chemical burns of the eye may destroy all of the corneal epithelium and large portions of conjunctival epithelium into the fornices. Restoration of the ocular surface after a chemical burn depends on the centritedal movement of conjunctival epithelial cells and their adherence to the altered corneal stroma. Epithelial movement after a corneal burn is normal for 72 hours after a burn, but persistent epithelial defects thereafter commonly are not resolved until total corneal vascularization occurs. Although this fresh epithelium may be protected by a bandage soft contact lens, more promising and far-reaching approaches may follow epithelial supplementation and even replacement. The link between the health and integrity of the epithelial layer as it relates to the corneal substratum and its cellular constituents remains to be forged.

Acids↗
PubMed1983

Chemical injuries of the eye.

This overview of the biochemical and pathophysiologic events after chemical burns of the eye is intended to act as a guide for appropriate therapy. Effective emergency measures must be instituted immediately followed by careful clinical evaluation to recognize and then treat problems at their inception. When and how to use the variety of drugs and devices is detailed. When these new methods and technology are applied successfully the clinical course may be improved and visual rehabilitation secured. The early results of conjunctival transplantation and hormonal therapy offer promise from experimental procedures. Exciting new treatments employing the foodstuffs ascorbate or citrate (orthomolecular therapy) are currently under investigation. The National Eye Institute sponsors our ongoing randomized clinical trial of these compounds in the treatment of the alkali burned eye. The outcome may change our thinking and our expectations after chemical burns of the eye.

Ascorbic Acid↗
PubMed1982

Effects of topical 10% ascorbate solution on established corneal ulcers after severe alkali burns.

When established corneal ulcers induced by alkali burning were treated with 10% ascorbate drops, no perforation occurred, in contrast to a 25% incidence in the control group. If perforations and descemetoceles were grouped together, these difference became insignificant (i.e., 14.2% ascorbate-treated vs. 25% control). Prolongation of descemetocele presence without perforation in the ascorbate-treated group indicated some therapeutic effect. We conclude that topical ascorbate does not substantially alter the outcome of established corneal ulcers.

Administration, Topical↗
PubMed1981

Prostatic carcinoma. Influence of tumor grade on results of pelvic lymphadenectomy.

Two hundred fifteen patients have undergone pelvic node dissection in clinical Stages A1, A2, B1, and B2 adenocarcinoma of the prostate as a final staging procedure. Two hundred four patients have had the tumor grade assessed adequately and the influence of the grade on the results of the node dissection evaluated. As the grade of the primary tumor worsens in each clinical stage, the incidence of positive nodes increases.

Adenocarcinoma↗
PubMed1981

The influence of parenteral ascorbate on the strength of corneal wounds.

Rabbits receiving subcutaneous ascorbate after corneal wounding showed significant elevation of aqueous humor ascorbate levels but no enhancement of wound breaking strength when compared to controls. In a second group of rabbits, perilimbal alkali burning reduced aqueous humor ascorbate levels one-half to one-third normal. In these perilimbally burned eyes with wounds in clear cornea, subcutaneous ascorbate significantly raised the aqueous humor ascorbate level and enhanced breaking wound strength compared to controls. We conclude that parenterally administered ascorbate has no salutory effect on the breaking strength of corneal wounds in the normal rabbit eye. In contrast, subcutaneous ascorbate has a very favorable effect on the breaking strengths of corneal wounds in those eye with depressed aqueous humor ascorbate.

Alkalies↗
PubMed1981

Sodium citrate reduces the incidence of corneal ulcerations and perforations in extreme alkali-burned eyes--acetylcysteine and ascorbate have no favorable effect.

Alkali-burned eyes (45 sec, 12 mm, 4N NaOH) were subjected to topical treatment with 10% ascorbate, 20% acetylcysteine, 10% ascorbate together with 20% acetylcysteine, 10% citrate, or Adsorbotear vehicle. Only citrate-treated eyes showed a significant decrease in corneal ulcerations and perforations (17%) compared with ascorbate (88%), acetylcysteine (81%), ascorbate/acetyl-cysteine (100%), or Adsorbotear (75%). In the citrate-treated eyes there was a significantly reduced incidence of band keratopathy (17%) but an increased incidence of hyphema (100%). Both groups receiving acetylcysteine developed acellular corneal caps, the result of peripheral ulceration undermining the central cornea. Polymorphonuclear neutrophils (PMN) were substantially increased at the base of the cap in the acetylcysteine- and acetylcysteine/ascorbate-treated eyes at day 56. At the end of the experiment, citrate-treated eyes showed substantially fewer stromal PMN than any other group. These results show that topical citrate has a most favorable effect on the incidence of corneal ulceration and perforation after alkali burning.

Acetylcysteine↗
PubMed1980

Corneal ulceration and perforation associated with Sjögren's syndrome.

Sterile corneal ulcerations and perforations associated with Sjögren's syndrome affected 18 eyes in 14 patients. Seven of the 18 eyes were perforated on presentation. Nine of the 18 eyes had received topical steroid treatment prior to referral. Two of the eyes had undergone recent anterior segment surgery and suffered perforated corneas postoperatively while receiving topical steroid treatment. All 14 patients had successful management of their corneal ulceration or management of their corneal ulceration or perforation (reepithelialization of the corneal defect, restoration or maintenance of the anterior chamber, and stromal scarring with visual acuity equal to or better than on presentation). Two of the 18 eyes had sterile infiltrated ulcers. We believe that this type of ulcer responds less predictably to therapy than the noninfiltrated lesions.

Adult↗