Biomedical subjects
Publications and source records attributed to J A Nesbitt.
A total of 528 patients have been treated with radical prostatectomy and node dissection during the last five years. Correlation of clinical and pathologic staging will be presented. Over 85 percent of these patients had Gleason scores of 6 or less. Patients who had nerve-sparing surgery had a potency rate of over 60 percent post surgery.
Ectopic location of the vas deferens is a rare congenital abnormality that has a spectrum of presentations. Such cases have been associated with anorectal anomalies. Knowledge of distal Wolffian duct embryology may help to explain the developmental steps involved in these anomalies, as well as provide theories for the variations that may be encountered. Vas deferens development is reviewed, and two cases of vas ectopia are presented to illustrate and lend support to current theories of normal and abnormal vasal embryology.
During the period of time from 1972 to 1987 a total of 104 radical prostatectomies were performed at the Ohio State University. From 1972 to 1985, standard radical retropubic prostatectomy was done in 60 patients and from 1986 to June 30, 1987, radical retropubic nerve-sparing prostatectomy was carried out in 44 patients. Transrectal ultrasound evaluation was available only for three quarters of the patients in the latter group. In the early part of the series, standard prostatectomy revealed 51 percent of the patients to have organ-confined disease and in the latter series 75 percent had organ-confined disease. In the earlier study only a retrospective analysis of the pathology reports was available, and in the latter study prospective evaluation was available with regard to pre- and postoperative staging, erectile function, blood loss and replacement, PSA data, and clinical and pathologic staging. It appears the radical nerve-sparing prostatectomy has several advantages including decreased blood loss, increased reservation of erectile function in 70 percent of the patients who were potent preoperatively, and a more accurate assessment of clinical stage prior to surgery through the use of transrectal ultrasonography.
To evaluate the usefulness of two new imaging modalities in the clinical staging of prostate cancer the following study was done. Twelve patients with biopsy-proved carcinoma of the prostate were evaluated preoperatively with magnetic resonance imaging (MRI) of the pelvis and transrectal ultrasound of the prostate. The main parameters evaluated were the ability of these two modalities to accurately predict capsular penetration and seminal vesicle involvement in these 12 patients: 10 went on to pelvic lymph node dissections, and 8 had radical retropubic prostatectomies. Thus the preoperative studies could be compared to the pathologic results. Based on our results we believe transrectal ultrasonography is more accurate in the assessment of seminal vesicle involvement and comparable to MRI in determining capsular penetration. Because of the lower cost of ultrasound we believe it to be both an economical and accurate way to preoperatively stage prostate carcinoma.
From August 1985 to January 1989, 100 patients were treated with radical nerve-sparing prostatectomy with epidural anaesthesia. Transrectal ultrasound evaluation was available for most of these patients. Using the anatomical techniques of early dorsal vein ligation, hypogastric artery control and epidural anaesthesia, blood loss was minimised and 55 patients required no transfusions. In addition, with the use of ultrasound, PSA determination and pelvic CAT scan, 73 of these 100 patients had organ-confined disease; 66 patients were potent pre-operatively and 42 are potent post-operatively.
From August 1985 to January 1987, 30 patients were treated with radical nerve-sparing prostatectomy with epidural anesthesia. Transrectal ultrasound evaluation was available for the vast majority of these patients. Utilizing the anatomic techniques of early dorsal vein ligation, hypogastric artery control, and epidural anesthesia, blood loss was kept to a minimum, with 22 patients requiring no transfusions in this series. In addition, with the use of ultrasound, PSA (prostatic-specific antigen) determination, and pelvic CAT scan, 22 of the 30 patients (75%) had organ-confined disease. Twenty patients were potent preoperative and 14 are potent postoperative, for a potency rate of 70%.
Three hundred twenty patients who were asymptomatic males aged 55-70 years, were evaluated with transrectal ultrasound in both the axial and sagittal projections to evaluate the efficacy of transrectal ultrasound in detecting early prostatic carcinoma. Thirteen patients had palpable nodules that were positive for prostatic carcinoma, and ten patients had normal rectal examinations but ultrasound abnormalities, which were confirmed with prostate biopsy positive for prostatic carcinoma. This preliminary report points to certain advantages of this screening procedure, but conclusions as to its efficacy must await the results of more extensive trials.
A total of 711 patients with symptomatic upper and lower urinary tract calculi underwent extracorporeal shock-wave lithotripsy (ESWL) at the Ohio Kidney Stone Center during the first six months. At follow-up 84 percent of the first 180 patients are stone-free. Retreatment was required for 2.8 percent of the patients with residual stone material. Thirty-seven percent of the treatments required cystoscopy with ureteral stent placement for manipulation of stones or delineation of distal ureteral anatomy to facilitate ESWL. Complications were minimal at less than 3 percent.
Two hundred forty asymptomatic males, aged fifty-five to seventy years, underwent transrectal ultrasound of the prostate as part of a screening examination in conjunction with The National Prostate Cancer Detection Project (NPCDP). Nineteen prostate adenocarcinomas were detected, eight of which were nonpalpable. Fifteen of these patients had pathologic Stage B, 2 had microscopic Stage C (seminal vesicle involvement), and 2 had Stage D2 (bone) disease. While the activity and treatment of the eight nonpalpable lesions remain in question, the diagnosis certainly was made only with this type of examination. The use of transrectal ultrasound as a screening tool must continue to be prospectively evaluated in a multicenter trial.
Serum concentrations of prostate-specific antigen (PSA), prostate-specific acid phosphatase (PAP), and transrectal prostatic ultrasound were utilized in the evaluation of 193 men with various urologic disorders. Of the 193 patients, 48 had prostate cancer, and the other 145 included 5 with genitourinary neoplasms, 69 with benign prostatic hypertrophy, and 71 with other non-neoplastic genitourinary disease. PSA levels were elevated in 35 patients with prostate cancer and in 25 of the 145 without prostate cancer. PAP levels were elevated in 15 with prostate cancer and in 2 of the 145 without prostate cancer. The data indicate that PSA is a more sensitive but less specific tumor marker than PAP in the detection of prostate cancer. PSA appears to be more sensitive than PAP in monitoring the response to treatment. The use of PSA and PAP jointly to detect and to monitor prostate cancer did not appear to enhance the clinical utility over that of PSA alone.
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Urinary diversion utilizing a continence-maintaining ileal valve has been performed in 12 canines. This procedure offers a simple surgical procedure and uses the diversion's internal fluid pressure to maintain continence. Of 12 canines with this continence-maintaining ileal valve, 11 remained continent at sacrifice. Operative complications were minimal and late complications occurred in 2 dogs. Histological evaluation of the diversionary tissues revealed slight changes in the mucosa of the ileal valve, with some flattening of the villi. This procedure may have a clinical role in urinary diversion for patients with pelvic malignancy or patients who need urinary diversion for other reasons.
Adriamycin used in combination with vitamin E (Tocopherol) was evaluated in the treatment of Nb rat prostate adenocarcinoma. Vitamin E has been shown to enhance the growth-inhibitory effects of adriamycin on human prostatic carcinoma cells in vitro. The adriamycin-vitamin E treatment groups had the lowest average final tumor volume, but the mortality rate was 57% (17/30). These results suggest that vitamin E may play a role in enhancing the cytotoxic effects of adriamycin, but may not have any protective effect on normal cells as previously suggested through in vitro methods.
Renal angiomyolipomas are generally benign tumors which are composed of smooth muscle, fat, and blood vessels. Classically these have been diagnosed with the use of arteriograms; however, since ultrasound and CAT scans have come into use these now are the common modalities for diagnosis. All angiomyolipomas generally can be followed conservatively, whereas larger ones have a tendency to bleed and require intervention. This paper reviews the diagnosis, treatment, and prognosis of patients with angiomyolipomas.
Transrectal ultrasonography has proved valuable in assessing the effect of primary treatment modalities for prostate carcinoma. This study shows patients who had a significant reduction in primary tumor volume had a significantly better prognosis and had less local symptoms than did the group of patients that did not have a significant reduction (less than 50%) in primary volume secondary to therapy. Patients were treated with either castration or Zoladex and all had Stage D2 cancer of the prostate.
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A 40-year-old woman with a history of alcohol abuse, drug-related suicide attempts, and depression presented with a flu-like illness, vomiting, and changes in mentation. On admission, therapeutic blood levels of salicylates, trazadone, and acetaminophen were found. A tentative diagnosis of a psychotic crisis with possible superimposed drug overdose was made. The etiology of the patient's acute encephalopathy remained unclear until a plasma ammonia and liver biopsy established the diagnosis of Reye's syndrome. The patient was given supportive therapy and recovered completely.
Since 1978 this laboratory unit has evaluated the Nb rat prostate adenocarcinoma model. More recently, over a 15-month period we have studied the Nb rat number one bladder tumor, a spontaneously appearing tumor in an aged female noble rat. Initial chemotherapeutic experiments have been carried out, revealing activity of this tumor to cyclophosphamide. Herein we report the feasibility of utilizing the subrenal capsular assay in the model. The advantage of this system is that one is able to determine the effect of chemotherapy in a very short time, i.e., 7 days. This method may save considerable expense and may serve as a useful projector for potential future chemotherapeutic trials of bladder cancer. In this assay system, cyclophosphamide, adriamycin, and cis-platinum and methotrexate did result in a significant decrease in tumor volume change. This change paralleled the results that we had seen in the past from the use of chemotherapy with cyclophosphamide alone in treatment of subcutaneous tumor nodules of bladder carcinoma. Further exploration of this method is warranted from a time efficiency as well as from a cost standpoint.