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Biomedical subjects

R S Foster

Publications and source records attributed to R S Foster.

At least 91 records · Page 5Linked to original sources
PubMed1995

Clinical stage B non-seminomatous germ cell testis cancer: the Indiana University experience (1965-1989) using routine primary retroperitoneal lymph node dissection.

Between 1965 and 1989, 1180 patients at Indiana University, U.S.A., underwent retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ cell (NSGC) testis cancer of whom 638 cases had primary RPLND. A subset of 174 cases were considered clinical stage B (or II) before surgery (retroperitoneal nodal metastases by clinical staging). Surgery revealed that 23% (n = 41) had pathological stage A disease (no cancerous nodes). This error rate in clinical staging has decreased somewhat with improved techniques, but remains approximately 20% over the last decade. The relapse rate in pathological stage A (n = 41) was 5% (n = 2), both of whom were cured by chemotherapy. The relapse rate in pathological stage B without postoperative adjuvant treatment (n = 54) was 35% (n = 19); 2 patients died. This indicates that 65% of pathological stage B cases were cured by RPLND alone. From 1979 to 1989, the 140 pathological stage B cases participated in a randomised prospective trial of post-RPLND adjuvant chemotherapy versus no postoperative treatment. Forty two per cent (n = 59) received postoperative platinum-based therapy (two cycles), and there has been no relapse after RPLND for stage B disease. While advances in chemotherapy for NSGC testis cancer have led to its application by several study groups to clinical stage B (or II) testis cancer (with surgery reserved only for those in partial remission), the equivalent cure rate with RPLND surgery with chemotherapy rescue reserved for those who relapse appears to have both cost and risk-benefit advantages.

Chemotherapy, Adjuvant↗
PubMed1995

Lodoxamide tromethamine treatment for superior limbic keratoconjunctivitis.

PURPOSE: We studied the efficacy of topically applied lodoxamide tromethamine 0.1% in the treatment of superior limbic keratoconjunctivitis. METHODS: Three patients with clinical findings of bilateral superior limbic keratoconjunctivitis. were treated with topical lodoxamide tromethamine four times daily in both eyes. RESULTS: While the patients were taking lodoxamide tromethamine, symptoms and objective findings resolved. CONCLUSIONS: Topically applied lodoxamide tromethamine 0.1% is useful in the treatment of superior limbic keratoconjunctivitis. There may be a role for mast cell stabilizers in the treatment of this disorder.

Administration, Topical↗
PubMed1995

Ectopic ureters and ureteroceles in adults.

Ectopic ureters and ureteroceles are typically diagnosed in childhood and rarely present in adults. Nevertheless, ureteral ectopia should be included in the differential diagnosis of older patients who present with urinary tract infections or urinary incontinence. Detection is often delayed because of inadequate evaluation and heightened awareness is necessary on the part of treating physicians. Earlier detection and proper diagnosis serves to minimize morbidity and, in some cases, may maximize the possibility of renal preservation. Case reports serve to highlight the spectrum of these uncommon but clinically important anomalies.

Adolescent↗
PubMed1995

Cystography after radical retropubic prostatectomy: clinical implications of abnormal findings.

OBJECTIVES: In many institutions, cystography is obtained routinely after radical retropubic prostatectomy to assess the integrity of the vesicourethral anastomosis before the removal of the catheter. This study presents the Indiana experience with cystograms performed following radical retropubic prostatectomy. METHODS: The experience with 260 cystograms performed in 245 consecutive patients following radical retropubic prostatectomy was reviewed retrospectively, with a special reference to the clinical implications of abnormal findings. RESULTS: After a standard catheterization period of 14 to 21 days (mean, 19.2), 94.3% of the catheters were removed safely without adverse clinical consequences. The presence of a minimal contained contrast extravasation did not affect outcome after the removal of the catheter. The overall incidence of clinically significant extravasation was found to be 5.7% and was further reduced to 2.4% if extravasation was not suggested clinically in the postoperative course. CONCLUSIONS: Based on the current literature, significant extravasation is a common finding during the first 5 to 8 postoperative days. Therefore, management strategies advocating early urethral catheter removal should include routine cystographic studies. Otherwise, cystographic confirmation of anastomotic integrity before the removal of the catheter following 14 to 21 days of catheterization is not indicated in the routine postradical prostatectomy patient.

Anastomosis, Surgical↗
PubMed1995

Early urethral catheter removal following radical prostatectomy: a pilot study.

OBJECTIVES: Postoperative urethral catheter drainage after radical prostatectomy is bothersome to patients. A pilot study was initiated to determine if urethral catheter removal prior to hospital discharge is feasible. METHODS: Thirty-three consecutive men undergoing radical retropubic prostatectomy were prospectively studied and followed for a minimum of 6 months (mean, 8.5). Postoperative cystography was utilized to direct early catheter removal. RESULTS: Of 33 patients, 27 (82%) underwent successful catheter removal at a mean of 4.2 postoperative days. No patient experienced urinary retention, urinoma development, pelvic abscess, or anastomotic stricture. Urinary continence is excellent (no pads required) in 70% and good (stress incontinence requiring 1 to 2 pads/24 hours) in 18% of patients at last follow-up. CONCLUSIONS: Following radical prostatectomy, early catheter removal prior to hospital discharge is feasible. Early results suggest no deleterious consequences. Prospective monitoring of more patients is needed to determine if this practice is widely applicable.

Adult↗
PubMed1995

The role of retroperitoneal lymphadenectomy in clinical stage B testis cancer: the Indiana University experience (1965 to 1989).

Between 1965 and 1989, 1,180 patients underwent retroperitoneal lymph node dissection for nonseminomatous germ cell testis cancer (638 underwent primary dissection). Of these patients, 174 were considered to have clinical stage B disease preoperatively (suspected retroperitoneal node metastases by clinical staging). Surgery revealed that 41 patients (23%) actually had pathological stage A disease (no cancerous nodes). This nonspecificity in clinical staging remains consistent despite advance in clinical staging methods during this 25-year period. Of the pathological stage B cancer patients 65% were cured by retroperitoneal lymph node dissection alone. These long-term data indicate that primary retroperitoneal lymph node dissection for low stage metastatic nonseminomatous germ cell testis cancer (pathological stage B) not only had diagnostic but also therapeutic impact. Furthermore, this cure rate with long-term followup is equivalent to that of current series of primary chemotherapy alone for stage B disease, which are still relatively early reports. This cure rate with single modality therapy (retroperitoneal lymph node dissection alone) was accomplished within an average of 4 hours and, therefore, should be more time and cost-effective than prior reports of 3 and 4 courses of primary chemotherapy. In the post-cisplatin era (1979 to 1989), 140 patients with clinical stage B disease were treated with primary retroperitoneal lymph node dissection: 32 (23%) had pathological stage A cancer and 2 of them (6%) had relapse. Both patients are currently disease-free with subsequent chemotherapy. Of the remaining 108 patients with pathological stage B disease 49 received no adjuvant chemotherapy and 59 received cisplatin-based adjuvant chemotherapy. Among the former 49 patients 18 (37%) had relapse and 2 died. No patient receiving postoperative cisplatin-based adjuvant chemotherapy had relapse. The overall survival rate in these 140 clinical stage B cancer patients was 98%. There were 3 deaths, only 1 from cancer. The addition of cisplatin-based adjuvant chemotherapy postoperatively has rendered pathological stage B nonseminomatous germ cell testis cancer entirely free of subsequent relapse. Therefore, retroperitoneal lymph node dissection as monotherapy is curative in two-thirds of the patients with stage II disease, while the remaining one-third with progression to clinical relapse can be reliably saved by chemotherapy. Future considerations in selecting therapy for clinical stage II nonseminomatous germ cell testis cancer will be risk-benefit, cost-benefit and quality of life issues. Several cooperative studies will examine these issues, involving European and United States groups.

Chemotherapy, Adjuvant↗
PubMed1995

Late relapse of testicular cancer.

PURPOSE: This study analyzed a large group of patients with testicular germ cell cancer in complete remission, who relapsed more than 2 years after completion of treatment. PATIENTS AND METHODS: A review of all patients treated at Indiana University Medical Center from 1979 through 1992 for late relapse was conducted. Eighty-one patients were treated for late relapse of testicular cancer. Forty-seven patients relapsed more than 5 years after successful management of their initial disease. RESULTS: At initial diagnosis, 35 patients had clinical stage I, 18 stage II, and 28 stage III disease. Twenty-three of 35 stage I, all 18 stage II, and all 28 stage III patients were treated by chemotherapy before their late relapse. The median follow-up duration of patients post-management of late relapse was 4.8 years. Twenty-one patients (25.9%) are continuously disease-free. Nineteen of these 21 patients had surgical resection of carcinoma or teratoma as a component of their therapy. Of sixty-five patients treated for late relapse by chemotherapy, 17 (26.2%) had a complete response, but only two have been continuously disease-free with chemotherapy alone. These two never received prior chemotherapy. CONCLUSION: Late relapse of testis cancer is more common than previously thought. Surgery is the preferred mode of therapy. Chemotherapy has only modest success in this entity, in contrast to the excellent results in de novo germ cell tumors. Patients treated for testicular germ cell cancer need annual follow-up evaluations throughout their life due to the possibility of late relapse.

Adolescent↗
PubMed1995

Hyperamylasemia after post-chemotherapy retroperitoneal lymph node dissection for testis cancer.

PURPOSE: Postoperative hyperamylasemia was evaluated in patients undergoing post-chemotherapy retroperitoneal lymph node dissection for testis cancer. MATERIALS AND METHODS: Serum levels of amylase, lipase and bilirubin were evaluated prospectively in the immediate postoperative period in 39 consecutive patients who underwent post-chemotherapy retroperitoneal lymph node dissection. RESULTS: Hyperamylasemia was found in 16 patients (41%), hyperlipasemia in 17 (43%) and hyperbilirubinemia in 9 (23%). Peak elevations were observed at 24 hours postoperatively and most returned to normal at 1 week. Elevation of these parameters was significantly associated with length and difficulty of the procedure. No patient demonstrated clinical acute pancreatitis. CONCLUSIONS: Extended retraction of the pancreas during post-chemotherapy retroperitoneal lymph node dissection may cause a minor reversible injury to the pancreas expressed as hyperamylasemia, hyperlipasemia and, rarely, jaundice. These findings are important to consider in the differential diagnosis of hyperamylasemia following post-chemotherapy retroperitoneal lymph node dissection.

Adolescent↗
PubMed1995

Prognostic significance of immunohistochemical proliferation markers (Ki-67/MIB-1 and proliferation-associated nuclear antigen), p53 protein accumulation, and neovascularization in clinical stage A nonseminomatous testicular germ cell tumors.

Histopathologic features alone fail to reliably stratify patients with clinical Stage A nonseminomatous germ cell tumors of the testis into groups with high and low risk for occult metastatic disease. Previous flow cytometric studies at Indiana University demonstrated a significant correlation between high proliferative activity and metastatic disease. The current study evaluated the prognostic significance of immunohistochemical markers related to tumor proliferation and aggressiveness in a consecutive series of clinical Stage A nonseminomatous germ cell tumors patients who underwent retroperitoneal lymph node dissection. Archival material of the orchiectomy specimens of 62 patients (45 pathologic Stage A, 17 with metastatic disease) was reviewed and immunohistochemically stained for Ki-67 antigen (MIB-1), proliferation-associated nuclear antigen (PC10), p53 protein (Pab1801), and Factor-VIII-related antigen (neovascularization). Staining with MIB-1 was significantly higher in the metastatic group (mean 80.2%, standard deviation [SD] 15.5) than in pathologic Stage A cases (66.3%, SD 27.9; P = 0.0032) and was predictive of metastatic status with a sensitivity of 82% and specificity of 69%. In this study, no patient with a MIB-1 value less than 52% had metastases. Proliferation-associated nuclear antigen and p53 staining correlated with MIB-1 values (R = 0.63 and 0.55, respectively) but did not correlate with metastatic status. Tumor angiogenesis was also not predictive of metastatic status. Assessment of proliferation rates using MIB-1 antibody in clinical Stage A nonseminomatous germ-cell-tumor patients may prove helpful in predicting metastatic status.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers, Tumor↗
PubMed1995

Improved accuracy of computerized tomography based clinical staging in low stage nonseminomatous germ cell cancer using size criteria of retroperitoneal lymph nodes.

PURPOSE: We evaluated the significance of retroperitoneal lymph nodes detected by computerized tomography (CT) of low stage nonseminomatous germ cell tumor patients. MATERIALS AND METHODS: A blind retrospective review of 143 CTs of low stage nonseminomatous germ cell tumor revealed pathological stage A disease on 89 (62.2%) and pathological stage B disease on 54 (37.8%). A multivariate logistic regression model was used to evaluate the relationships between diameter of the retroperitoneal nodes detected in these CTs and pathological stage. RESULTS: Based on this model, as the diameter of the nodes increased within a 0 to 25 mm. range, the likelihood of pathological stage B disease increased in a continuous fashion. Using a 3 mm. threshold to define nonmetastatic nodes the sensitivity and negative predictive value of CT based staging was 90%. CONCLUSIONS: This measurement scheme improves the accuracy of staging compared to conventional methods.

Algorithms↗
PubMed1995

The clinical implications of procedural deviations during orchiectomy for nonseminomatous testis cancer.

PURPOSE: The clinical implications of procedural deviations during orchiectomy for nonseminomatous testis cancer were evaluated. MATERIALS AND METHODS: A retrospective review was done of 78 of 1,708 patients (4.6%) with nonseminomatous testis cancer who presented to our university following scrotal violation. RESULTS: A total of 56 patients (71.8%) underwent hemi-scrotectomy as part of treatment. A tumor was found in 6 of 56 hemi-scrotectomy specimens (10.7%) and 3 showed local recurrence. Of the 78 patients 5 (6.4%) had local recurrence, while 1 of 30 (3.3%) with scrotal specimens negative for tumor had recurrence in the groin. No patient treated by chemotherapy had local recurrence. CONCLUSIONS: Scrotal violation was associated with an increased risk for local recurrence mainly when a residual tumor in the scrotectomy specimen was found. The role of hemi-scrotectomy to avoid of local or systemic relapse is debatable.

Adolescent↗
PubMed1995

Late relapse of clinical stage I testicular cancer.

PURPOSE: The clinical presentation and treatment of late recurrence (2 or more years after initial management) of testis cancer are defined. MATERIALS AND METHODS: A retrospective search was performed to identify patients treated for late relapse at our university from 1979 to 1992 who had initially presented with clinical stage 1 disease. RESULTS: We treated 35 patients with chemotherapy for late relapse. No patient has remained disease-free with chemotherapy alone. Subsequent surgery resulted in 43% of the patients being currently disease-free. CONCLUSIONS: The treatment of late relapse is surgical. Chemotherapy before late relapse for low volume disease does not uniformly prevent late recurrence.

Adult↗
PubMed1995

[New parameters for prediction of pathological stage in clinical stage I non-seminomatous testicular tumors].

Traditional histopathological risk factors have failed to predict pathological stage accurately in clinical stage I nonseminomatous testicular germ cell tumours. Histopathology, flow cytometry, cytophotometry, and immunohistochemical staining techniques were used in an effort to define high- and low-risk groups for occult metastasis in a consecutive series of 105 patients who underwent retroperitoneal lymph node dissection. After multiple logistic regression analysis, the proliferative S + G2M cell cycle fraction of the aneuploid tumour stemline was the most highly predictive parameter of pathological stage (P = 0.0004). Using a cut-off of 41%, pathological stage II patients were predicted with a sensitivity of 71%. There were 61 patients with S + G2M values below 41%, and 43 of them had pathological stage I disease (negative predictive value 87%). A low volume of embryonal carcinoma was predominant in low-risk patients, and MIB-1 immunohistochemical staining identified a subgroup of 23% of patients with pathological stage I disease and at extremely low risk of metastatic disease. Assessment of tumour cell proliferation does not allow accurate classification of high-risk patients at a level that is adequate for clinical application. Patients who are at low risk of metastasis, however, can be identified by flow cytometry, immunohistochemical proliferation markers and volume of embryonal carcinoma with 90% certainty. These parameters deserve further study, since identification of a subgroup of patients at extremely low risk of metastasis could potentially reduce the overall morbidity in the management of clinical stage I nonseminomatous testis cancer.

Animals↗
PubMed1995

Surgical anatomy of the lumbar vessels: implications for retroperitoneal surgery.

The lumbar vessels in the retroperitoneum must be addressed during many urological and vascular procedures. Few studies have assessed the exact pattern of the lumbar vasculature, and most anatomical descriptions suggest the presence of a generally regular pattern. The number and location of the infrarenal lumbar arteries and veins were documented in 102 consecutive retroperitoneal lymph node dissections. Anomalies of the renal vessels were also noted. The lumbar arteries followed a fairly regular pattern and individual variation occurred mainly in the number of lumbar arteries exiting the aorta (range 2 to 4). Great variation existed among the lumbar veins. The most common pattern of lumbar arteries (60% of the cases) included 3 paired vessels exiting posteriorly at every third of the infrarenal aorta and coursing diagonally toward the lumbar foramina. There was great variation in the number and location of lumbar veins along the inferior vena cava. Commonly 3 lumbar veins entered on the left (44%) and 2 on the right (37%) sides. A lumbar vein entering the left renal vein was documented in 43% of the cases. Accessory renal arteries were found in 24 cases (24%). The number and course of the lumbar vessels are more variable than previously described in the medical literature. Knowledge of these anatomical variations is important for surgeons operating in the retroperitoneum. Several techniques to maintain control of the lumbar vessels are described.

Aorta, Abdominal↗
PubMed1995

Color Doppler flow imaging for deep venous thrombosis screening in patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostatic carcinoma.

Patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy are traditionally considered to be at high risk for postoperative venous thromboembolic complications. A prospective deep venous thrombosis screening regimen was initiated at our medical center in 1990 following 2 cases of fatal pulmonary embolism that occurred after hospital discharge. During a 3-year period 245 consecutive patients undergoing radical retropubic prostatectomy for prostate cancer were screened postoperatively for lower extremity deep venous thrombosis using ultrasound duplex scanning with color Doppler flow imaging. The results were correlated only with the development of clinical deep venous thrombosis. No additional diagnostic modalities were used to confirm a normal venous system in asymptomatic patients. Venous thromboembolic complications were encountered in 9 of the 245 patients (3.6%). In 2 patients deep venous thrombosis was associated with nonfatal pulmonary embolism. Only 2 of the 9 cases of deep venous thrombosis were detected by color Doppler flow imaging screening. The striking decrease in the incidence of deep venous thrombosis following radical prostatectomy in the last decade and the low yield of screening at a single point in time may warrant reconsideration of the need for deep venous thrombosis screening among patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostate cancer.

Adult↗
PubMed1995

Complications of post-chemotherapy retroperitoneal lymph node dissection.

The surgical morbidity rate of 603 patients who underwent lymphadenectomy after primary chemotherapy for clinical stages II and III testis cancer from 1982 to 1992 was reviewed. There were 144 complications in 125 patients (20.7%). The majority of patients (93%) had a tumor volume of greater than 5 cm. Five patients died 3 to 47 days postoperatively, for an operative mortality rate of 0.8%. Pulmonary complications were the most frequent cause of severe morbidity: 6 patients had the adult respiratory distress syndrome and 5 needed prolonged ventilation. The underlying cause was a combination of bleomycin induced pulmonary toxicity, and large volume retroperitoneal and pulmonary disease resected in these patients. Limiting inspired oxygen concentration and perioperative volume replacement are imperative to minimize bleomycin related pulmonary morbidity. Additional procedures, such as nephrectomy and colectomy, did not add to the morbidity rate. Among patients undergoing concomitant venacavectomy there was a higher occurrence of postoperative chylous ascites. Most of the other complications (gastrointestinal, lymphatic, neurological and renal) were temporary and treated conservatively. Perioperative management of the post-chemotherapy testis cancer patient is different from that of the patient undergoing primary retroperitoneal lymphadenectomy. The latter operation is usually performed in physically fit patients and the surgical template of dissection is of a smaller scale. Thus, the complications in this group are minor and without mortality. Specific technical considerations and difficulties are common to post-chemotherapy patients. Factors, such as large volume of disease, post-chemotherapy desmoplastic reaction and extensive retroperitoneal dissection, make these patients more prone to have complications. Decreased pulmonary, renal and nutritional reserves add to the surgical morbidity. Knowledge of possible pitfalls and their causes can avoid unnecessary operative complications.

Combined Modality Therapy↗
PubMed1995

Adaptations of the Mitrofanoff principle in adult continent urinary reservoirs.

Among the different techniques to develop a continence mechanism in continent urinary diversion, the Mitrofanoff principle of creating a submucosal tunnel for implantation of a catheterizable tube has gained in popularity. Early experience in the pediatric population focused on use of the appendix and ureter as the efferent limb, while bladder served as the reservoir. Recent developments have demonstrated that any segment of bowel can be tapered and implanted to achieve continence. Colonic teniae serve as an ideal site for implantation of the tube. The continence achieved with implantation of a supple straight tube beneath a tenia of colon is excellent. Success with this form of continence has made it our preference when converting an ileal or colon conduit to a continent reservoir.

Adult↗