Biomedical subjects
Publications and source records attributed to R S Foster.
The major objection to the use of retroperitoneal lymphadenectomy in low-stage testis cancer has been the universal loss of ejaculatory ability if a full bilateral dissection is performed. The Indiana University experience with nerve-sparing dissection is presented. One hundred percent of the patients subjected to this procedure maintain ejaculatory ability.
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This study investigated breast self-examination (BSE) frequency and quality and determinants of BSE practice in two samples of women: (a) women of childbearing age who were of lower income and lower education and (b) women of childbearing age who were of higher income and higher education. Mothers recruited from a pediatric practice completed a questionnaire addressing BSE frequency and quality and factors derived from the Health Belief Model that might influence performance. Results indicated that there were no differences in mean BSE frequency or quality between the two samples. Regression analyses revealed that the perceived barriers index, consisting of forgetting, exclusive reliance on medical personnel for breast exams, and low confidence in ability to perform BSE, was the single best predictor of BSE frequency, accounting for 67% of the variance in each sample of women. When quality of BSE was examined, knowledge of BSE was the best predictor.
Hyperprolactinemia is a recognized cause of impotence. The discovery of elevated prolactin levels in impotent men is very important since pharmacotherapy in this instance is highly successful. We review our experience with prolactin determinations in impotent men, and a population is defined that may benefit from routine prolactin determination. In our experience, the predominant symptom associated with hyperprolactinemia in men is loss of libido.
Extension of renal cell carcinoma into the vena cava is found in 4 to 10 percent of patients. One key to successful surgical management is defining the superior extent of the thrombus. Currently, this is accomplished by using inferior venacavography. The limitations of this imaging technique include difficulty in defining the superior extent of the thrombus and determining the presence of hepatic vein involvement. We report our experience using magnetic resonance imaging (MRI) in 9 patients to stage the thrombus and to determine the operative approach. We believe that MRI supplants other imaging techniques for staging tumor thrombi in renal cell carcinoma.
This study reports on the effects of innovative community-wide breast self-examination education approaches in increasing breast self-examination frequency and quality, and ability to detect breast lumps during a 1-year training program and a second-year maintenance program. Four Vermont communities were randomly assigned to receive breast self-examination training plus maintenance, training alone, control (with full measurement), and low-measurement control. Random digit dialing telephone surveys were conducted at baseline and at 1- and 2-year follow-up with a panel of 637 women representing all adult women in the first three communities. The low-measurement control community received only baseline and second-year follow-up surveys with a panel of 238 women. Home interviews to determine breast self-examination palpation skills and lump detection on silicone breast models were conducted in first- and second-year follow-up surveys. Results of the first-year follow-up survey indicated significant increases in breast self-examination frequency, quality, and number of lumps detected for women in communities receiving the training program compared with controls; in the second year, women in the community also receiving breast self-examination maintenance showed greater improvement in reported breast self-examination quality and detected more breast lumps than did women in other communities.
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.
A 62-year-old white man had diffuse transitional cell carcinoma of a right ureteral stump 2 1/2 years after initial transurethral resection of a bladder tumor and right radical nephrectomy for renal cell carcinoma. This case and review of the literature suggest an indication for complete ureterectomy in nephrectomy candidates with prior or concurrent transitional cell carcinoma of the bladder.
We report 2 cases of symptomatic suture granuloma formation after erosion of the silk suture (used to ligate the dorsal venous complex) into the urethrovesical anastomosis. Irritative or obstructive voiding complaints, sterile pyuria or hematuria found after radical retropubic prostatectomy mandates urological evaluation, including cystoscopy to rule out anastomotic suture granuloma formation. Although erosion appears to be a rare occurrence, we recommend use of absorbable suture to control the dorsal venous complex and avoid this possible complication.
Thirty elderly patients with primary operable breast cancer were treated initially, because of refusal of surgery or because of infirmity, only with the antiestrogen tamoxifen citrate. Nineteen patients had regression of the primary tumor (complete in five and partial in 14). Eight patients were stable with no change, and three had measurable increases in the size of their primary tumors. Nine of the 30 eventually required locoregional treatment with surgery or radiotherapy for progression or recrudescence of their tumors after initial regression. No patient developed uncontrollable locoregional disease. For selected geriatric patients, treatment with tamoxifen alone permits a delay of surgery, which for some exceeds life expectancy.
A plicated ileocecal segment was used to construct an antirefluxing urinary conduit in 3 patients. Each patient had markedly dilated or shortened ureters that prevented conventional Leadbetter ureteral reimplantation into a colon conduit. Ascending colon was brought out as a cutaneous stoma, the ureters were anastomosed to ileum, and an antireflux mechanism was created from plicated terminal ileum and the native ileocecal valve. Significant reflux was prevented in all 3 patients. This technique provides a means to prevent urinary reflux into short or dilated ureters, and increases the versatility of the ileocecal segment for use in diversion and urinary tract reconstruction.
All existing continent urinary reservoirs utilize cecum and/or varying lengths of ileum. In patients who have received prior pelvic radiation therapy, continent diversion has not been feasible because those segments of bowel lie within the field of irradiation. We describe a new technique of continent diversion utilizing only bowel outside the field of pelvic irradiation. A urinary reservoir is constructed from reconfigured transverse colon. A tubularized segment of stomach is implanted beneath the taenia of the reservoir to provide a continent, catheterizable stoma. We describe this technique in detail and report our results in five dogs followed for a mean of 59 days.
While many of the basic principles of breast cancer management are the same for younger and older women, a number of breast cancer issues particularly important for elderly women have not been resolved. Many of these management questions need answers based on data that are better than that currently available. At what age should the clinician consider cessation of screening mammography? For which very elderly patients might tamoxifen alone be adequate treatment for primary operable breast cancer? How can we develop better guidelines for the selection and administration of cytotoxic chemotherapy in an elderly population? What is the appropriate systemic adjuvant therapy, if any, for the patient over the age of 70? These and other questions may be answered through the development of clinical trials directed specifically at the elderly population.
Extraction of a tumor thrombus in the vena cava from a renal cell carcinoma is a technically demanding but gratifying procedure. We describe a technique for isolation of the superior vena cava during thrombus extraction using an inferior vena caval to atrial shunt.
We report the fifth case of a rare testicular serous papillary cystadenomatous tumor of low malignant potential. All patients presented with a testicular mass. Histologically, the tumor can be differentiated from testicular papillary cystadenocarcinoma. The natural history of this rare tumor is yet to be determined.
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In summary, the complications of retroperitoneal lymph node dissection for low-stage testis cancer appear to be minimal, especially with the advent of nerve sparing techniques. However, the approximate 30 per cent of patients who require primary chemotherapy and do not attain a complete remission are candiates for postchemotherapy retroperitoneal lymphadenectomy, and these patients are subject to a higher risk of intraoperative and postoperative complications. Maintaining awareness of these potential complications may aid in preventing morbidity in this group of patients.
Breast self-examination (BSE) practices and attitudes of three groups of women were compared using a mailed survey. Subjects were 59 women with previous breast cancer, 33 women with previously treated benign breast lump(s), and 80 general-population women with no history of breast disease. Groups were compared on frequency, proficiency, and knowledge of BSE. Determinants of practice were examined using attitudinal variables from the Health Belief Model. Results indicated that the breast cancer group had significantly higher rates of BSE frequency, proficiency, and knowledge than did the general-population group. The breast cancer group perceived cancer to be significantly less threatening than did the other two groups, although the general-population group reported significantly less susceptibility to breast cancer. Within-group analyses revealed that barriers to BSE practice accounted for the greatest amount of variance in BSE frequency in all three groups. These results are discussed.