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Biomedical subjects

L R Rubin

Publications and source records attributed to L R Rubin.

At least 19 recordsLinked to original sources
PubMed1994

Fertility considerations in nerve-sparing retroperitoneal lymph-node dissection.

Nerve-sparing retroperitoneal lymph-node dissection (RPLND) maintains the patient's ability to ejaculate postoperatively. However, since testicular cancer patients sometimes have diminished spermatogenesis, questions have been raised as to the advisability of nerve preservation relative to ultimate fertility. Fertility status was assessed in clinical stage A patients by two methods. These included standard semen analysis and a post-RPLND survey. The results show that approximately 75% of non-seminomatous testicular cancer patients who present in clinical stage A have fertility potential as based on semen analysis. Additionally, of those patients responding to the post-RPLND survey who had attempted pregnancy following RPLND, 76% reported attainment of pregnancy. Nerve-sparing RPLND maintains fertility potential in clinical stage I patients; furthermore, this fertility potential appears to be worth preserving as many patients will be capable of impregnating their partners.

Ejaculation↗
PubMed1994

The fertility of patients with clinical stage I testis cancer managed by nerve sparing retroperitoneal lymph node dissection.

Nerve sparing retroperitoneal lymph node dissection reliably preserves emission and ejaculation in patients with clinical stage I nonseminoma. The fertility of 51 patients who underwent nerve sparing retroperitoneal lymph node dissection was assessed by 3 different methods: standard semen analysis, analysis of chromatin content by deoxyribonucleic acid histogram and assessment of ultimate fertility status by a questionnaire. Approximately 75% of these patients have semen analyses generally considered to be in the normal range. Virtually all patients who underwent deoxyribonucleic acid histogram analysis had histograms similar to controls. A retrospective analysis of fertility was performed in 201 patients who had previously undergone nerve sparing retroperitoneal lymph node dissection. Of these patients who attempted pregnancy after nerve sparing retroperitoneal lymph node dissection 76% have been successful. Approximately 75% of patients who present with clinical stage I nonseminoma are potentially fertile. Nerve sparing retroperitoneal lymph node dissection is capable of preserving this potential in allowing these patients to father children.

Female↗
PubMed1992

Growth hormone-releasing hormone-like messenger ribonucleic acid and immunoreactive peptide are present in human testis and placenta.

Although the sequence of human GH-releasing hormone (GHRH) has been determined, all of the information concerning gene expression has been based on pathological sources of ectopic GHRH, since the only established physiological source of GHRH in humans is the hypothalamus. We recently reported the presence of extrahypothalamic GHRH-like mRNA and immunoreactive material in rat testis and placenta. To determine if human testis and placenta also contain immunoreactive GHRH-like peptides, tissue extracts were analyzed using enzyme-linked immunosorbent assay methodology. Both tissues had detectable quantities of immunoreactive peptide recognized by a monoclonal antibody to synthetic human GHRH-(1-44) (testis, 2.4 ng/g tissue, 0.68 ng/mg protein; placenta, 2.6 ng/g tissue, 0.36 ng/mg protein). The origin of these peptides was confirmed by extracting total RNA from human testis and placenta, with analysis on Northern blots probed with riboprobes for rat hypothalamic GHRH cDNA and human pancreatic tumor GHRH cDNA. Human testis and placenta total RNA both contain an approximately 790-nucleotide RNA species similar in size to that reported in ectopic GHRH-producing human tumors. In addition, two larger hybridization signals were seen at 3000 and 4900 nucleotides. These data suggest that testis and placenta are extrahypothalamic sites of expression of the human GHRH gene. Normal expression of the GHRH gene in extrahypothalamic sites may include transcription of larger mRNA species than those observed in ectopic pathological sources of GHRH expression.

Animals↗
PubMed1991

Detection of antisperm-antibodies in patients with primary testicular cancer.

Serum antisperm-antibodies have been noted to develop as a result of various types of testicular pathology and injury. Their presence sometimes correlates with impaired fertility. We examined 52 patients with non-seminomatous low-stage testicular cancer for the presence of serum antisperm-antibodies to determine whether or not auto-immunity is a factor in the depressed fertility known to exist in these patients. Twenty-one per cent were discovered to have serum antisperm-antibodies using an immunofluorescent technique.

Autoantibodies↗
PubMed1991

Andrology: the study of male fertility.

Approximately 10 million men and women in the United States are unable to have children due to medical problems directly affecting their fertility. Of those couples seeking medical intervention, 30% to 50% of the infertility problems are diagnosed as male problems. Andrology, the study of male fertility, has grown in response to the need for laboratory services and research facilities. The repertoire of diagnostic tests currently available to the clinician includes enhanced semen analysis, antisperm antibody assay, sperm penetration assay and hemizona assay. Some of the laboratory techniques designed for improvement in semen data and/or storage of the specimen are sperm washing, sperm "rise" and cryopreservation. The andrology laboratory is a support service to the family practitioner, the urologist and the reproduction specialist. With state-of-the-art technology, physicians are better able to address infertility, minimize patient distress and provide patients with reasonable options.

Fertility↗
PubMed1989

Anatomy of the nasolabial fold: the keystone of the smiling mechanism.

The nasolabial fold is absent in the face of the newborn, disappears in the paralyzed face, but is retained in the face upon death. There is very little information in the literature on what makes up the fold. Four fresh cadavers were studied by taking a strip of facial tissue from each at right angles to the fold; all soft tissue layers through the face were included. Microscopic studies of the strips showed the fold to be made up of (1) dense fibrous tissue, (2) muscle fibers branching from the levator muscles of the upper lip, and (3) striated muscle bundles originating in the fold fascia. The studies also revealed the lip elevator muscles and the "fold muscles" coursing down the lip to traverse the orbicularis oris and insert into the dermis of the upper lip, the cutaneous vermilion junction, and vermilion. The smile is formed in stages, the first stage raising the lip to the fold by the levator muscles and the muscle bundles originating in the fold. The lip meets resistance at the fold because of cheek fat. The second stage involves the raising of the lip and fold upward by the levator muscles of the upper lip. Clinically, this study relates to reanimating the paralyzed face.

Adipose Tissue↗
PubMed1986

Reanimation of the long-standing partial facial paralysis.

Those unfortunate people who suffer from permanent partial facial paralysis have great difficulty finding surgeons who can offer corrective operations. Improving their function is a most delicate procedure. Great care must be exercised to avoid injuring nerves and muscles which are still operating, although in a greatly diminished state. The pathogenesis must be understood before attempting any corrective procedure. Adequate time must elapse from the moment of injury to surgical intervention, thus allowing for maximal nerve and muscle regeneration. This paper describes techniques that could improve facial movements. The most frequently used procedure is shortening of the levator and/or the zygomatic muscles that are partially atrophied. It must be understood that total reanimation is impossible as of this time.

Adolescent↗
PubMed1984

In vitro elevation of red blood cell 2,3-diphosphoglycerate with fructose, phosphate, and methylene blue.

2,3-Diphosphoglycerate (2,3-DPG) is an important regulator of hemoglobin oxygen affinity and thus can theoretically affect tissue oxygenation. Marked stimulation of DPG with substances that would likely be well tolerated by humans has not been reported previously. In order to achieve such stimulation, we investigated (n = 102) the effect of various combinations of fructose (2.8-11.1 mM) and sodium phosphate (1.0-130.0 mM) on 2,3-DPG production by perfusing fresh human blood in dialysis tubing, 37 degrees C, pH 7.15-7.70, with the appropriate solutions and with compressed air or 100% O2 for up to 6 hours. The DPG increased significantly with fructose/phosphate incubations for 6 hours. At pH greater than 7.35 the average increase was 25%; at pH less than 7.35, 12%; PO4 greater than 6 mM + pH greater than 7.35 yielded the highest changes, 28%. Methylene blue 2.5-7.5 microM + PO4 greater than 2.5 mM + pH greater than 7.35 yielded similar results. Glucose + PO4 showed no effect on DPG. Results were comparable at all fructose levels either with compressed air or 100% O2. Significant elevations in 2,3-DPG were also noted at 4 hours but were of lesser magnitude. In conclusion, significant elevations in 2,3-DPG can be achieved by incubating whole blood with fructose/phosphate solutions or with methylene blue and phosphate for 4-6 hours. It should be possible to adapt these solutions for human use to raise 2,3-DPG. The potential physiologic value of rightward shifts in hemoglobin oxygen affinity can then be tested under appropriate conditions.

Adult↗
PubMed1984

Anatomical alterations in locus coeruleus neurons in the adult spontaneously hypertensive rat.

A golgi-Cox examination of the locus coeruleus in the spontaneously hypertensive rat (SHR) has shown an increase in the number of primary dendritic branches, in the number of secondary branch points, in the mean length of the dendritic branches from the soma to the outer extent of the secondary branches, and in the longest extent of the dendritic domain in comparison with the locus coeruleus in the Wistar-Kyoto normotensive rats at sixteen weeks of age. We suggest that the anatomical changes may provide a substrate for altered afferent relationships in the neurochemical regulation of neurons of the locus coeruleus, although it remains to be shown whether such alterations are related in any way to blood pressure. It appears evident that the altered mechanisms resulting in hypertension in this genetic model are more complex than an anatomical or neurochemical modification in one of the central autonomic nuclei. However, the present finding that anatomical alterations in the dendritic arborizations of a key nucleus such as the locus coeruleus occur, points towards a need for further examination of the interrelationships of specific neurotransmitter systems in this nucleus.

Animals↗
PubMed1984

Reanimation of the hemiparalytic tongue.

Tongue hemiparesis is the inevitable result when the freshly severed 12th nerve is anastomosed to the trunk of a paralyzed 7th nerve in the technique commonly used by neurosurgeons, head and neck surgeons, otologists, and plastic surgeons to treat unilateral facial paralysis. This author has reactivated hemiparalytic tongues after research on cats. The technique has now been proved to be successful on two human beings. The reanimation is based on a simple Z-plasty of tongue muscle across the midline. Two principles are established: (1) placing a normal muscle in direct contact with a denervated muscle stimulates axons from the normal side to penetrate into the denervated side, eventually restoring function, and (2) transposition of a flap of muscle from the normal side containing extrinsic tongue muscles could provide a motor apparatus to activate the paralytic side. Biopsy slides taken from the paralyzed side of the cat tongues after 18 months showed sprouting of multiple nerves. Nerve sprouting can be found in human tongues 1 year after Z-plasties. The two patients who experienced atrophy and hemiparesis after the 12th-7th nerve hookup regained full range of tongue movements by 2 months and 4 months, respectively, demonstrating that with time, motor axons from the normal side innervated the atrophic muscle side to form new neuromotor junctions resulting in tongue movements. EMGs of the reanimated tongue showed normal activity in both sides of the tongue. Biopsies of the interface between the normal and former paralyzed side taken 1 year later showed nerves crossing the scar barrier. Apparently, the role of additional extrinsic muscle to the paralyzed side played a minor role.

Animals↗
PubMed1984

Prophylactic mastectomy with immediate reconstruction for the high-risk woman.

Prophylactic mastectomy should provide the woman at high risk for breast cancer with some degree of assurance that the surgical procedure is of benefit in preventing the occurrence of cancer. The so-called subcutaneous mastectomy fails because too much breast parenchyma is left to preserve the blood supply to the undisturbed nipple-areola complex. The procedure of choice described here removes the nipple-areola complex, thins and cores it, and replaces it as a free graft when the breast parenchyma is removed. A high-profile silicone breast implant is inserted into a pocket made of pectoralis major muscle, serratus anterior muscle, and a deepithelialized skin flap.

Adult↗
PubMed1979

One preventable cause of spontaneous deflation of inflatable mammary prostheses.

Spontaneous "overnight" deflation of inflatable prostheses is rather uncommon, but we have had a 5.7% incidence of it in a 24-month period in which we used implants with a suturable tab and fastened them to the subjacent fascia. At exploration we found these tabs had torn the bag of the implant, usually at the vulcanized seam. We now believe that fixing a suture tab on a breast implant to underlying fascia may cause undue stresses upon the implant at that point and result in an otherwise avoidable deflation.

Adult↗