PubMed Health⌕ Search

Biomedical subjects

J E Oesterling

Publications and source records attributed to J E Oesterling.

At least 217 records · Page 12Linked to original sources
PubMed1987

Metachronous bilateral Wilms tumor. Report of longest-known survivor and guidelines for conservative management.

In a one-year-old black male patient a classic Wilms tumor of the left kidney was treated with left nephrectomy, chemotherapy, and irradiation to the entire abdomen. Two years later a mature Wilms tumor, consisting predominantly of rhabdomyomatous elements, was discovered in the right kidney. Although a second course of chemotherapy was given and 2,000 rad were delivered to the right flank, the mass continued to enlarge with progressive deterioration of renal function. A nephron-sparing procedure was performed, in which a 3,400-g tumor measuring 19 cm X 16 cm X 9 cm was enucleated from the right kidney without compromise to the remaining normal tissue. Pathologic examination of the surgical specimen revealed a mature Wilms tumor with a malignant anaplastic sarcoma arising in the central portion. Currently, he is disease-free with normal renal function more than twenty years after diagnosis of the metachronous bilateral Wilms tumor. We believe he is the longest known surviving metachronous Wilms tumor patient and emphasizes the importance of conservative, meticulous surgery in the management of both unilateral and bilateral Wilms tumors. The role of multimodal therapy (chemotherapy, irradiation, and surgery) as well as the current guidelines for the management of bilateral Wilms tumors as proposed by the National Wilms Tumor Study are reviewed.

Combined Modality Therapy↗
PubMed1987

Correlation of clinical stage, serum prostatic acid phosphatase and preoperative Gleason grade with final pathological stage in 275 patients with clinically localized adenocarcinoma of the prostate.

The usefulness of clinical stage, serum prostatic acid phosphatase and preoperative Gleason grade in predicting final pathological stage in patients with adenocarcinoma of the prostate remains controversial. To determine the predictive value of these 3 preoperative variables we reviewed 275 patients with clinically localized disease who were treated between April 1982 and February 1986. All patients were examined preoperatively and subsequently were operated upon by 1 urologist. Serum prostatic acid phosphatase was determined in all patients by the Roy method using thymolphthalein monophosphate as the substrate. The Gleason grade of each prostatic biopsy specimen was determined preoperatively by 1 pathologist, who also examined the final pathological specimen with respect to capsular penetration, and seminal vesicle and pelvic lymph node involvement. Using logistic regression analysis with the likelihood ratio chi-square test, clinical stage and Gleason grade had a direct correlation with capsular penetration (p less than 0.0001 and less than 0.0001, respectively), seminal vesicle involvement (p less than 0.0001 and less than 0.0001, respectively) and positive lymph nodes (p less than 0.0001 and less than 0.0002, respectively). Within the normal range of values (0.0 to 0.8 IU/l.) serum prostatic acid phosphatase correlated directly with capsular penetration (p less than 0.003) and seminal vesicle involvement (p less than 0.01) but not with lymph node involvement (p equals 0.08). Again with logistic regression analysis we determined that the best predictors of final pathological stage are not individual variables but models that use combinations of preoperative variables. The models generated are as follows: capsular penetration--serum prostatic acid phosphatase and Gleason grade (p less than 0.00001), seminal vesicle involvement--clinical stage and Gleason grade (p less than 0.00001), and lymph node involvement--clinical stage and Gleason grade (p less than 0.00001). With these models probability plots have been constructed so that the final pathological stage in patients with clinically localized prostatic cancer can be predicted preoperatively.

Acid Phosphatase↗
PubMed1987

A unified approach to early reconstructive surgery of the child with ambiguous genitalia.

Gender assignment in the newborn with ambiguous genitalia poses a dilemma for the parents and physician, even if the infant has a normal 46XX or 46XY karyotype. In general, female pseudohermaphrodites are reared as female subjects, since they can undergo reconstruction to appear as phenotypic female subjects and they may even be able to bear children. Male pseudohermaphrodites, patients with mixed gonadal dysgenesis and male patients with a micropenis may not be so straightforward, and proper gender assignment in these infants may be difficult. A unified surgical approach to early reconstruction of the external genitalia in these patients, who are to be reared as female subjects, has been developed. Essential to this perineal reconstruction are phallic reduction and recession in which erectile tissue is removed with preservation of the neurovascular bundles and glans, creation of labia minora from flaps of phallic skin and foreskin, a labioscrotal Y-V plasty to produce normal-appearing labia majora and construction of a neovagina with a perineal flap. If the patient is a male pseudohermaphrodite or an infant with a micropenis creation of the vagina is deferred until late adolescence or young adulthood. In other patients in whom the vagina enters the urethra or urogenital sinus proximal to the external sphincter a pullthrough vaginoplasty is performed when the child is 2 to 3 years old. If the vaginal entry is distal to the external urinary sphincter a flap vaginoplasty is performed at the same time as the phallic reduction, and creation of the labia minora and labia majora during infancy. Ten patients (4 with the adrenogenital syndrome, 2 male pseudohermaphrodites, 2 genetic male patients with a micropenis, 1 with mixed gonadal dysgenesis and 1 true hermaphrodite) have undergone reconstruction with this composite procedure. All 10 patients have had a successful cosmetic and early functional result.

Adrenal Hyperplasia, Congenital↗
PubMed1987

Intravesical herniation of small bowel after bladder perforation.

Intravesical small bowel herniation is a rare complication of bladder perforation, with only 1 case reported previously. We describe 2 additional patients in whom the diagnosis of bladder perforation was delayed or made difficult because the herniated small bowel presented as a filling defect without significant extravasation of contrast medium on cystography. In both patients additional investigative procedures were necessary to establish the diagnosis preoperatively.

Accidental Falls↗
PubMed1987

A simple substitute for a missing segment of the proximal anterior urethra.

We describe 2 patients with an absent segment of the bulbomembranous urethra, in 1 of whom the defect extended from the triangular ligament to the scrotal area. A simple method to restore continuity is presented, which is applicable to a wide variety of conditions resulting in the absence of a long segment of the bulbomembranous urethra.

Carcinoma↗
PubMed1987

The importance of a successful initial bladder closure in the surgical management of classical bladder exstrophy: analysis of 144 patients treated at the Johns Hopkins Hospital between 1975 and 1985.

The staged functional closure of classical bladder exstrophy has produced improved results for many urologists involved in the surgical management of this congenital anomaly. To determine which factors are most important for achieving a successful outcome (urinary continence with preservation of normal renal function) the 144 patients treated at The Johns Hopkins Hospital between 1975 and 1985 were reviewed. Of these patients 51 were managed entirely at our institution, while 93 had had the initial surgical treatment elsewhere. All patients who had undergone primary bladder closure and bladder neck reconstruction were divided into 2 groups: group 1--patients who had a successful initial bladder closure (an exstrophied bladder that is converted into a complete epispadias without wound infection, dehiscence or any degree of bladder prolapse on the first attempt) and group 2--children whose initial bladder closure was not successful. Both groups were analyzed with respect to bladder capacity at the time of bladder neck reconstruction, time required for the bladder to become sufficiently large for bladder neck reconstruction, urinary continence rate, and interval between bladder neck reconstruction and achievement of urinary continence. Patients in group 1 had the largest bladders at the time of bladder neck reconstruction (mean capacity 79 cc, p equals 0.03), shortest intervals between primary closure and bladder neck reconstruction (mean 3.5 years, p equals 0.006), highest urinary continence rate (92 per cent, p equals 0.002), and the shortest interval between bladder neck reconstruction and achievement of urinary continence (mean 1.5 years, p equals 0.18). These findings suggest that a successful initial bladder closure is an important factor for obtaining a larger bladder more quickly and for achieving a high urinary continence rate in patients with classical bladder exstrophy undergoing the staged functional bladder closure.

Bladder Exstrophy↗
PubMed1987

Transitional cell carcinoma of the bladder in an adolescent with Turner's syndrome.

Primary epithelial tumors of the bladder are extremely rare in children and adolescents. We report a case of transitional cell carcinoma in an adolescent with Turner's syndrome. The patient presented with intermittent gross hematuria and mild dysuria. A mass was identified on the trigone of the bladder near the left ureteral orifice, and histological evaluation revealed grade II to III in situ papillary transitional cell carcinoma with foci of submucosal invasion. Transurethral resection of the tumor was performed, and the patient remains free of disease 2 1/2 years later. The literature on transitional cell carcinoma of the bladder in children is reviewed.

Adult↗
PubMed1987

Prostate-specific antigen as a marker for prostatic cancer: a monoclonal and a polyclonal immunoassay compared.

We evaluated the clinical utility of prostate-specific antigen (PSA) in diagnosis and management of prostatic cancer, using a monoclonal immunoradiometric assay (M-PSA) and a polyclonal radioimmunoassay (P-PSA). Assay CVs ranged from 1.3% to 4.9% (M-PSA) and from 5.1% to 8.0% (P-PSA). Detection limits were 0.1 microgram/L (M-PSA) and 0.2 microgram/L (P-PSA). Reference intervals established for healthy men were: 0-2.8 micrograms/L (M-PSA) and 0-4.2 micrograms/L (P-PSA). The regression equation for the PSA concentrations (0-100 micrograms/L) measured in normal men, men with primary prostatic cancer, and men with benign prostatic hypertrophy (BPH) was: P-PSA = 1.603 M-PSA - 0.120 microgram/L (r = 0.9923, n = 201). The P-PSA calibrators yielded one-half their assigned values when analyzed by the M-PSA assay. With either assay there were proportional increases in PSA values with advancing cancer. The proportion of PSA values exceeding the reference interval was 50% for patients with stage A prostatic cancer, 80% (stage B), 100% (stages C and D), and 65% for men with BPH. After radical prostatectomy, the follow-up PSA values for most patients were within the reference intervals for women (0-0.2 microgram/L for M-PSA, 0-0.8 microgram/L for P-PSA). Most patients with above-normal PSA values have clinically detectable disease.

Antibodies↗
PubMed1986

The inability of adrenal androgens to stimulate the adult human prostate: an autopsy evaluation of men with hypogonadotropic hypogonadism and panhypopituitarism.

Although it is well recognized that testicular androgens provide the major hormonal stimulus to the prostate the role of adrenal androgens is less certain. Recently, it has been suggested that total androgen ablation (adrenal and testicular) is necessary to achieve a complete response to hormonal therapy in men with carcinoma of the prostate. In an effort to elucidate the influence of adrenal androgens on prostatic growth, we reviewed autopsy findings in patients (mean age 65 years, with a range of 57 to 80 years) from 3 distinct groups: group 1 consisted of 4 men with neither adrenal nor testicular function since before puberty (panhypopituitarism), group 2 included 4 men with normal adrenal glands but no testicular function throughout life (hypogonadotropic hypogonadism or prepubertal castration) and group 3 consisted of 8 age-matched controls with normal adrenal glands and normal testes. To assess the degree of androgenic stimulation each prostate was examined by a genitourinary pathologist and was analyzed morphometrically with respect to epithelial cell height, epithelial cell height: nuclear height ratio, acinar area and short axis diameter of randomly selected acini. All prostates in groups 1 and 2 were atrophic histologically, while all prostates in group 3 were enlarged and demonstrated varying degrees of benign prostatic hyperplasia. Morphometric analysis of the 3 groups revealed the same results. For all 4 parameters studied morphometrically there was no statistical difference between groups 1 and 2. However, a statistical difference did exist for these criteria when either group 1 (p less than 0.0001) or group 2 (p less than 0.0001) was compared to group 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Glands↗
PubMed1986

Frozen section detection of lymph node metastases in prostatic carcinoma: accuracy in grossly uninvolved pelvic lymphadenectomy specimens.

We reviewed our frozen section experience with 310 pelvic lymphadenectomy specimens during the last 5 years. A total of 40 patients (12.9 per cent) had positive lymph nodes on permanent section. In 6 of these patients the lymph nodes were involved grossly and in 34 there were only microscopic metastases. Intraoperative assessment of lymph node involvement classified correctly 299 patients (96.5 per cent of the total number). Whereas previous studies have demonstrated a failure on frozen section to detect all but a few microscopic metastases, we were able by frozen section to identify metastases in 23 of 34 patients (67.6 per cent) with grossly uninvolved lymph nodes. Of the positive frozen sections 16 were in patients with unilateral metastases only, and in 13 of these cases frozen section identified the only positive node present. The average diameter of the metastases found on frozen section was 2.4 mm. In 11 of the 34 patients frozen section did not disclose any of the metastases present on permanent sections (average 1.4 mm.) (false negative rate 3.5 per cent of all patients, 27.5 per cent of those with positive nodes and 32.3 per cent of those with microscopic involvement of lymph nodes only). Ten patients had unilateral metastases and 1 had bilateral involvement. The ability to identify the majority of microscopic metastases, given their adverse effect on prognosis, supports the usefulness of routine frozen section on grossly uninvolved pelvic lymph nodes as a staging procedure before radical prostatectomy.

Frozen Sections↗
PubMed1986

Xeroradiography and ultrasonography in the evaluation of a penile injury.

A 34-year-old white man presented with severe penile cellulitis following injection of epoxy glue into the shaft of the penis. Preoperative xeroradiography and ultrasonography localized the hardened masses of glue to the left corpus cavernosum and subcutaneous tissues. Under the guidance of intraoperative ultrasonography this foreign material was removed surgically. Postoperatively, the cellulitis resolved promptly and xeroradiography demonstrated no residual fragments. Although various modalities, including computerized tomography and roentgenography, are available to detect foreign bodies in soft tissues, xeroradiography and ultrasonography are ideally suited for use in the male external genitalia.

Adhesives↗
PubMedDate not supplied

The decision to seek care. Factors associated with the propensity to seek care in a community-based cohort of men.

OBJECTIVE: To investigate factors associated with a high propensity to seek care. DESIGN: Cross-sectional baseline component of a prospective cohort study. SETTING: Olmsted County, Minnesota. SUBJECTS: A randomly selected, community-based cohort of 2115 men aged 40 to 79 years on January 1, 1990. MEASUREMENTS: Participants completed a questionnaire that elicited information about the propensity to seek care by means of 7 hypothetical scenarios about physical illness. Also queried was the self-reported outpatient physician utilization in the previous year and sociodemographic factors. RESULTS: There was a significant association between propensity to seek care and physician utilization. Men with a high propensity to seek care were more likely to have had 4 or more physician visits (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3-2.3). Bivariate analysis suggested significant associations between a propensity to seek care for physical reasons and retirement (OR, 2.0; 95% CI, 1.1-2.6), age of 65 years or more (OR, 1.9; 95% CI, 1.5-2.4), incomplete high school education (OR, 1.6; 95% CI, 1.1-2.2), and an annual income of less than $25,000 (OR, 1.4; 95% CI, 1.1-1.9). Multivariable logistic regression analysis demonstrated that retired men were more likely to have a high propensity to seek care (OR, 1.7; 95% CI, 1.2-2.4), with the other variables no longer-being significant. CONCLUSIONS: Our findings suggest an association between propensity to seek care and physician utilization and retirement. In view of the increasing numbers of aged persons in the United States, this relatively higher propensity to seek health care among retired men may have a greater impact on the cost of health care for the aged than is fully appreciated.

Adult↗
PubMedDate not supplied

Influence of male hormones on rates of ethanol elimination in man.

The effect of a reduction in androgens on ethanol elimination was determined in man. Bilateral therapeutic orchiectomy in nine patients for prostatic carcinoma decreased mean plasma testosterone levels from 489.8 +/- 31.2 (S.E.) ng per dl to 55.3 +/- 3.8 ng per dl and resulted in an increase in the rate of ethanol elimination in seven patients, no change in one, and a decrease in one. The mean rate of ethanol elimination for all nine patients increased from 83.6 +/- 4.0 to 100.4 +/- 4.2 mg per kg body weight per hr (p less than 0.02). The most likely mechanism for an increase in ethanol elimination after orchiectomy is an increase in liver alcohol dehydrogenase content, which remains to be demonstrated in man.

Aged↗
PubMedDate not supplied

Staging of prostate cancer.

The clinical and pathologic staging of prostate cancer involves determination of the anatomic extent and burden of tumor based on the best available data. Two major classification schemes are currently used: the modified American system and the TNM system [primary tumor (T), regional lymph node (N), and metastases (M)]. Both systems stratify patients according to the method of tumor detection, separating nonpalpable "incidental" prostate cancers detected during transurethral resection for clinically benign prostatic hyperplasia (BPH) and palpable cancers detected by digital rectal examination. These staging systems also recognize nonpalpable tumors detected by an elevated serum prostate-specific antigen (PSA) level or an abnormal transrectal ultrasound image. Current staging is limited by a significant level of clinical understaging (up to 59%, in our experience) and overstaging (up to 5%) according to comparison with pathologic examination of resected specimens. Proposed improvements in staging include preoperative systematic sextant biopsies to assess tumor volume, volume-based prognostic index, and a multiple prognostic index. In this report, we evaluate the current aspects of clinical and pathologic staging of prostate cancer with emphasis on the early stages in which there is the greatest chance of cure.

Evaluation Studies as Topic↗
PubMedDate not supplied

Diagnostic markers of prostate cancer: utility of prostate-specific antigen in diagnosis and staging.

The optimal tumor marker for prostate cancer would be effective for early detection, staging, and monitoring patients after definitive treatment. This marker would have a high sensitivity, specificity, and positive predictive value for distinguishing men with benign prostatic hyperplasia (BPH) from men with early prostate cancer. Such a marker would consistently detect biologically significant disease, correlate with clinical and pathologic staging, and predict prognosis. In addition, this marker would be accurate at indicating cure or progression of disease after treatment. Certainly, the ideal marker also would be reproducible, inexpensive, generate results rapidly, be easy to perform, be accessible to clinicians, and tolerable to patients. Unfortunately, such a "super" marker does not exist at this time. However, prostate-specific antigen (PSA) has many of the aforementioned capabilities. This article will describe the current utility of PSA in the diagnosis and staging of prostate cancer.

Acid Phosphatase↗
PubMedDate not supplied

The origin and development of benign prostatic hyperplasia. An age-dependent process.

Although the exact cause of benign prostatic hyperplasia (BPH) is not well defined, it is thought to occur as the result of epithelial-stromal interactions in the appropriate hormonal milieu. Benign prostatic hyperplasia originates in the periurethral and transition zones of the prostate in a microscopic (histologically identifiable) state as early as the third decade of life. With advancing age and the presence of androgens, approximately 50% of microscopic BPH will develop into macroscopic (palpably enlarged prostate) BPH. However, clinically significant BPH necessitating treatment will develop in only 50% of men with an enlarged prostate gland. In the United States, the estimated risk of a 50-year-old man undergoing a prostatectomy in his lifetime is approximately 25% to 40%. If left untreated, a significant number of symptomatic patients will remain stable or improve without adverse sequelae.

Adult↗