Depression often culprit in male menopause.
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Climacteric↗
Biomedical subjects
P A Nash
Publications and source records attributed to P A Nash.
En bloc nephrectomy in patients undergoing post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous testis cancer: indications, implications and outcomes.
PURPOSE: We review the indications for nephrectomy at post-chemotherapy retroperitoneal lymph node dissection, identify patients at risk for nephrectomy and assess the impact of nephrectomy on outcome. MATERIALS AND METHODS: Using a computerized data base and chart review we retrospectively reviewed the records of 848 patients who underwent retroperitoneal lymph node dissection after chemotherapy. RESULTS: En bloc nephrectomy was performed at retroperitoneal lymph node dissection after chemotherapy in 162 of the 848 patients (19%). The indications for nephrectomy included contiguous involvement of perirenal structures in 73% of the cases, renal vein thrombosis in 6%, a poorly functioning or nonfunctioning renal unit in 5% and a combination of these conditions in 16%. Pathological studies of the hilum revealed cancer in 20% of the cases, teratoma in 49% and fibrosis in 31%. Patients requiring nephrectomy had significantly more advanced disease and larger disease volume at presentation and after chemotherapy. There were no significant differences in perioperative morbidity or mortality compared with patients who did not undergo nephrectomy. Only 3 patients required perioperative dialysis and none required long-term renal support. CONCLUSIONS: These findings support en bloc nephrectomy at post-chemotherapy retroperitoneal lymph node dissection in select patients with large volume perihilar retroperitoneal disease.
Adult↗
Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction for glanular carcinoma in situ with significant urethral extension.
OBJECTIVES: To report the use of conservative extirpative surgical techniques to manage glanular carcinoma in situ with significant urethral extension. METHODS: Over a 5-year period, 2 patients with carcinoma in situ of the glans with significant distal urethral involvement, who refused penectomy, were managed with combined treatment modalities using Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction. RESULTS: At follow-up of 5 years and of 12 months, there has been no evidence of meatal or proximal urethral recurrence. CONCLUSIONS: Mohs' micrographic surgical excision and distal urethrectomy with immediate urethral reconstruction offers an acceptable alternative to partial penectomy in patients with perimeatal carcinoma in situ who fail conservative treatment or refuse penectomy.
Aged↗
Transrectal ultrasound guided prostatic nerve blockade eases systematic needle biopsy of the prostate.
PURPOSE: We assessed the effect of transrectal ultrasound guided prostatic nerve blockade on the discomfort associated with systematic needle biopsy of the prostate. MATERIALS AND METHODS: A prospective randomized double-blind study was performed of 64 patients requiring systematic biopsy of the prostate. Patients were randomly assigned to receive an injection of 5 ml. 1% lidocaine or 5 ml. saline (0.9% sodium chloride) at the vascular pedicle on 1 side of the prostate only. They were then asked to score the severity of discomfort of the injection and subsequent biopsies on each side. RESULTS: Mean pain scores were significantly lower on the side with than the side without lidocaine injection (1.6 +/- 0.9 versus 2.4 +/- 1.2, p < 0.0001) and not significantly different when saline was injected (2.9 +/- 1.2 versus 3.0 +/- 1.1, p = 0.52). Pain scores were significantly different when the lidocaine injected side was compared to the saline solution injected side (p < 0.0001) but the difference was not significant between the noninjected sides of the 2 groups (p = 0.076). Of the patients in the lidocaine group 68% reported that they would prefer to undergo biopsy with the injection compared to only 41% in the placebo group (p = 0.037). During the study no patient in either group had any adverse effect from the injection. CONCLUSIONS: Transrectal ultrasound guided nerve blockade before prostatic biopsy results in a more comfortable procedure for the patient.
Biopsy, Needle↗
Spinal cord ischemia after post-chemotherapy retroperitoneal lymph node dissection for nonseminomatous germ cell cancer.
PURPOSE: We report and analyze several cases of neurological deficit after post-chemotherapy retroperitoneal lymph node dissection that were though to be related to spinal cord ischemia. MATERIALS AND METHODS: We searched the testis cancer data base at our university, which includes 1,447 retroperitoneal lymph node dissections performed from 1982 to 1994, to identify patients who had postoperative neurological complications. The history and clinical course of patients suspected to have spinal cord ischemia were reviewed and potential risk factors were analyzed. RESULTS: The incidence of spinal cord ischemia after post-chemotherapy retroperitoneal lymph node dissection was 0.56% (4 of 712 patients). CONCLUSIONS: Spinal cord ischemia may complicate the course of post-chemotherapy retroperitoneal lymph node dissection in testis cancer patients. Older age, extensive retroperitoneal dissection, prior therapy and certain anesthetic parameters may predispose nonseminomatous germ cell tumor patients to spinal cord ischemia. These risk factors may be used to define a subset of high risk patients, and active measures should be taken in an attempt to minimize the frequency of spinal cord ischemia in these patients.
Adult↗
Discordance between the site of primary nonseminomatous germ cell tumor of the testis and retroperitoneal metastatic disease secondary to anomalous venous drainage of the testis.
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Adult↗
The impact of pre-donated autologous blood and intra-operative isovolaemic haemodilution on the outcome of transfusion in patients undergoing radical retropubic prostatectomy.
OBJECTIVE: To assess the impact of pre-donated autologous blood and intra-operative isovolaemic haemodilution on the outcome of transfusions in patients undergoing radical retropubic prostatectomy. PATIENTS AND METHODS: The charts and transfusion records of 192 consecutive patients undergoing radical retropubic prostatectomy were reviewed retrospectively. RESULTS: Of 192 patients, 14% required homologous transfusions, the rate of which varied significantly depending upon blood availability (autologous, haemodilution or homologous) (P < 0.001): 66% of patients with only autologous blood available were transfused a mean of 1.96 units (range 1-6) of blood, of which 87% received autologous alone. 12% both autologous and homologous and 1% homologous blood only. Of the pre-donated autologous units, 44% were wasted. CONCLUSIONS: Both the pre-donation of autologous blood and intra-operative isovolaemic haemodilution lower the risk of homologous blood transfusion. It is recommended that patients pre-donate 2 units of autologous blood and undergo intra-operative isovolaemic haemodilution before radical prostatectomy.
Blood Transfusion, Autologous↗
Acute retroperitoneal hemorrhage due to transitional cell carcinoma of the renal pelvis.
A young, otherwise healthy man was hospitalized with clinical findings of acute retroperitoneal hemorrhage. Radiographic evaluation suggested a large bleeding renal mass that was thought to be renal cell carcinoma. Radical nephrectomy was performed after angio-embolization. Final pathological diagnosis was grade III transitional cell carcinoma of the renal pelvis invading the renal parenchyma. Distal ureterectomy was subsequently performed 12 days after nephrectomy. Preoperative or intraoperative diagnosis of transitional cell carcinoma would have spared our patient the morbidity of a delayed second procedure. Transitional cell carcinoma of the renal pelvis should be considered in the differential diagnosis of acute retroperitoneal hemorrhage.
Acute Disease↗
Nephrectomy for traumatic renal injuries.
During a 16-year period 2,521 patients presented to our institution with renal trauma. Renal exploration was performed in 195 patients (202 renal units), with 31 units requiring exploration alone, 145 repair and 26 nephrectomy, yielding an overall nephrectomy rate of 13%. A detailed review of these 26 patients identified them as a unique population: all had major renal injuries, and as a group they demonstrated significantly higher rates of shock, injury severity scores, transfusion requirements and death rates than those in whom exploration with renal salvage was possible. In no case was nephrectomy required as a complication of exploration or attempted repair. In the properly staged patient undergoing surgery for appropriate indications with early vascular control exploration of renal injuries is safe. It is not the exploration that results in the nephrectomy but the injury itself.
Adult↗
Adrenalectomy via the dorsal approach: a benchmark for laparoscopic adrenalectomy.
PURPOSE: We reviewed our experience with posterior surgical excision of aldosteronomas. MATERIALS AND METHODS: A retrospective review identified 40 consecutive cases performed by 1 surgeon. RESULTS: Mean patient age was 46 years and mean blood loss was 237 cc. There was no perioperative mortality or intraoperative complications. Times to unassisted ambulation and return to a normal diet were 2.2 and 2.4 days, respectively, with a mean postoperative hospital stay of 4.4 days. CONCLUSIONS: The removal of aldosteronomas via the dorsal approach is a safe reliable technique with acceptable morbidity. These results provide a benchmark by which the results of laparoscopic adrenalectomy may be judged.
Adrenal Cortex Neoplasms↗
Arteriovesical fistula after pancreatic transplantation.
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Adult↗
Sono-urethrography in the evaluation of anterior urethral strictures.
During a 7-year period 123 paired urethrographic and sono-urethrographic studies were performed on 101 patients with 110 urethral strictures. In all but 3 cases the urethra was subsequently evaluated either cystoscopically or at open operation. Sono-urethrography readily identified urethral calculi, diverticula and false passages. It correctly identified the stricture and its site in every case. There was a significant difference between stricture length as measured by urethrography compared to that measured by sono-urethrography (p < 0.003). However, if the strictures were grouped based on anatomical location, there was good correlation and no significant difference in the penile urethra (correlation coefficient = 0.94, p = 0.74) but poor correlation and the significant difference remained in the urethral bulb (correlation coefficient = 0.64, p < 0.007). Similarly, when urethrographic and sono-urethrographic stricture lengths were compared with operative lengths, in the penile urethra the correlation coefficients were close (correlation coefficient = 0.91 versus 0.98) but in the urethral bulb the poor correlation persisted (correlation coefficient = 0.69 versus 0.89). Although sono-urethrography certainly identifies periurethral tissue, it was unreliable in predicting the depth of spongiofibrosis when compared with full depth biopsies in 36 patients with histopathological correlation. Finally, in 16% of the patients sono-urethrography correctly indicated a reconstructive procedure different from that originally suggested by conventional urethrography. Sono-urethrography is a dynamic 3-dimensional study that accurately identifies stricture site, number and caliber. Compared with conventional urethrography, it more accurately measures stricture length and diameter, and identifies periurethral tissue, making it a valuable adjunct in the evaluation of patients with suspected anterior urethral strictures.
Biopsy↗
Comparison of saphenous vein patch, polytetrafluoroethylene patch, and direct arteriotomy closure after carotid endarterectomy. Part I. Perioperative results.
To evaluate the perioperative outcomes and the immediate increases in size after patch closure, 140 carotid endarterectomies were randomized into one of three groups: direct no-patch closure, saphenous vein patch closure, and polytetrafluoroethylene patch closure. Seven patients (4.4%) experienced signs of cerebral ischemia in the immediate postoperative period. In three cases this was transient and reversible. In the other four reexploration was undertaken and carotid thrombosis was corrected by thrombectomy. The condition of one of these patients deteriorated to a permanent stroke, whereas the other patients made a complete recovery. Neurologic complications were more frequent in the no-patch group, but the differences between the groups were not significant. The incidence of perioperative internal carotid stenosis, aneurysmal dilatation, and other morphologic abnormalities was assessed in 131 intravenous digital subtraction angiograms taken before the patient was discharged from the hospital. Eight (17.0%) of the endarterectomies in the no-patch group were narrowed by 30% to 50% diameter stenosis, whereas none of the patched arteries had more than 30% stenosis. In contrast, dilatation of the common or internal carotid artery to more than twice the measured diameter was absent in non-patched arteries but was present in seven (17.0%) saphenous patch closures and four (9.23%) polytetrafluoroethylene patch closures. We conclude that patch closure after carotid endarterectomy is less likely to cause stenosis in the perioperative period. Poly-tetrafluoroethylene patches resist dilatation better than do saphenous vein patches and are less likely to become aneurysmal.
Aged↗
Prospective randomized trial of polytetrafluoroethylene and Dacron aortic prosthesis. I. Perioperative results.
Over a two year period 80 patients were entered into a prospective randomized trial comparing polytetrafluoroethylene (PTFE) and Dacron infrarenal aortic reconstructions. Fifty-four patients were treated for aneurysm (30 single tubed grafts; 24 bifurcation grafts), and 26 patients were treated for occlusive disease (26 bifurcation grafts). The groups were matched for age, sex and preoperative risk factors. Five patients died after operation (6.3%) including two from hemorrhage, but there were no significant differences in mortality and morbidity between the PTFE and Dacron groups. The volume of blood lost at operation (1930 +/- 1340 ml, all patients); the volume of blood transfused (2.98 +/- 2.43 units); the volume of crystalloids infused (3050 +/- 1390 ml); the intraoperative heparin dosage (67.9 +/- 20.5 mg); the clamp time (71.6 +/- 34.5 min); and the total operating time (228.1 +/- 78.3 min) also showed no significant differences between PTFE and Dacron. The ankle systolic pressure index rose more for PTFE (0.96 +/- 0.24) than for Dacron (0.82 +/- 0.20; P less than 0.002) at the time of discharge. This partially reflects a difference in the index between the groups before operation (PTFE 0.79 +/- 0.30; Dacron 0.72 +/- 0.32), but it may also indicate that PTFE is less thrombogenic than Dacron.
Aged↗
Perforation of the gastrointestinal tract by a toothpick.
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Colon↗
Effects of Rathke's pouch mesenchymal cells on growth hormone and prolactin release from pituitary clonal cells.
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Cell Differentiation↗
The dose response of human intraocular pressure to pilocarpine.
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Aged↗
The acute response of indium-111 labelled platelets to arteriotomy closure.
A standard 40 mm arteriotomy was created in canine iliac and carotid arteries and then closed by either direct suture without a patch, with a vein patch or with a polytetrafluoroethylene patch (PTFE). The uptake of 111-Indium oxine labelled platelets at 2 hours after operation was compared between the groups. Arteriotomies closed with a PTFE patch demonstrated significantly greater platelet aggregation than those closed with a vein patch. Primary closure without a patch was associated with the least platelet uptake of all (PTFE versus vein patch, P less than 0.01; PTFE versus no patch, P less than 0.01; vein patch versus no patch, P less than 0.05). Light and electron microscopy confirmed the radioisotopic findings.
Animals↗